Tratamento pelo fluconazol de pacientes imuno-comprometidos com graves infecções fúngicas Treatment by fluconazole of severe fungal infections in immunocompromised patients

Abstract

Avaliou-se a eficácia do fluconazol no tratamento de infecções fúngicas em 108 pacientes imunocomprometidos. As doses iniciais variaram de 50 a mais de 400 mg/dia. Dos 108 pacientes, 57 (52,8%) tinham criptococose, 45 (41,7%) candidíase e 6 (5,5%) outras infecções fúngicas, sendo que 66,6% dos pacientes eram portadores de AIDS. Dos 57 pacientes com criptococose houve acometimento do SNC em 52 (91,2%); 39 de 43 pacientes com criptococose (90,7%) e 36 de 39 dos portadores de candidíase (92,3%) curaram ou tiveram boa evolução clínica. A erradicação do fungo ocorreu em 19 de 30 casos com criptococose (63,3%) e em 21 de 26 casos com candidíase (80,7%) que puderam ser avaliados. Onze dos 108 pacientes (10,2%) apresentaram reações adversas,principalmente gastrintestinais de pequena intensidade, porém um paciente apresentou envolvimento hepático na vigência de terapêutica com fluconazol. Conclui-se que o fluconazol é droga eficaz e de baixa toxicidade para tratar criptococose e candidíase, constituindo-se boa alternativa à terapêutica convencional com anfotericina B.Fluconazole therapy was evaluated prospec-tively in 108 patients with immunossupression and serious fungal infections. Patients were enrolled if they had a life-threatening fungal infection and conventional therapy had failed to eradicate infection, had caused serious toxic reactions, or was contraindicated. Patients were treated with 50 to over 400 mg/day initially. AIDS was underlying risk factor in 66.6% of the patients evaluated in the study and in 92.9% of 57 patients with cryptococcal infection. Satisfactory clinical response was observed in 43 patients with active cryptococcal infection and in 39 patients with active candidiasis, 90.7% and 92.3% respectively. Concerning mycologic response, 63.3% and 80.7% of 30 patients with cryptococcal infection and 26 patients with candidiasis respectively had final negative cultures. Eleven patients (10.2%) had adverses effects possibly due to fluconazole therapy. Fluconazole may be effective in the treatment of cryptococcal infection and candidiasis and can be an alternative to conventional antifungal therapy.

Keywords

• Terapêutica antifúngica
• Fluconazol
• Candidíase
• Criptococose