基于两性霉素B药物浓度的优化隐球菌性脑膜炎治疗方案的临床研究OA

Objective To evaluate the efficacy and safety of rapid dosing optimization for amphotericin B in treating non-HIV cryptococcal meningitis through monitoring drug concentration.Methods A total of 62 non-HIV patients diagnosed with cryptococcal meningitis admitted to Jiangxi Chest Hospital between 2021 and 2024 were divided into rapid dosing group[0.5-0.7 mg/(kg·d)within 3 days]and conventional treatment group[0.5-0.7 mg/(kg·d)requiring>3 days].Treatment outcomes and adverse events were compared to optimize clinical management.Results No significant difference in overall response between two groups after 4 weeks.However,rapid dosing treatment protocol showed significantly higher efficacy(91.18％vs.71.43％,P<0.05).Adverse events included infusion reactions(14.71％vs.10.71％),liver dysfunction(23.53％vs.21.43％),renal impairment(35.29％vs.28.57％),hypokalemia(38.24％vs.39.29％),and bone marrow suppression(14.71％vs.14.29％).No statistically significant differences were observed between groups(P>0.05).Conclusion Rapid dose escalation of amphotericin B deoxycholate can improve the early treatment effect of cryptococcal meningitis without increasing the occurrence of adverse drug reactions.Through the monitoring of amphotericin B drug concentration,it was found that the higher cerebrospinal fluid concentration of amphotericin B in the early stage may be the reason why the effective rate of rapid dose escalation group was higher than that of conventional treatment group.