氟康唑联合制霉菌素体外抗白念珠菌阴道分离株的实验研究

The Study of Combination of Fluconazole with Nystatin against Isolates of Vaginal Candida albicans in Vitro

目的评价外阴阴道白念珠菌对氟康唑联合制霉菌素作用的敏感性,探讨两种药物间相互作用的方式。方法参照美国国家实验室标准委员会(NCCLS)M27方案(1997)推荐的棋盘微量稀释法,检测22株分离自外阴阴道念珠菌病患者的白念珠菌对氟康唑、制霉菌素以及两药物联合的体外药物敏感性试验。结果联合用药时,氟康唑MIC值的几何均数从7.5114μg/mL显著降低到2.4162μg/mL,制霉菌素MIC值的几何均数从2.0640μg/mL显著降低到0.6297μg/mL,27.3%(6/22)受试菌表现为协同作用方式,72.7%(16/22)的受试菌株表现为相加作用方式,无受试菌株(0/22)表现为无关作用方式,未发现有拮抗作用。测定不同浓度下药物单独和联合作用的一株菌的菌落形成单位(cfu/mL),联合用药组合较单独用药有显著减少。结论氟康唑与制霉菌素联合应用可增强体外抗白念珠菌的作用。

Objective To evaluate the sensitivity of 22 clinical isolates of Vaginal Candida albicans to the combination therapy of fluconazole and nystatin and their in-vitro interactions. Methods A checkerboard titration broth microdilution-based method that adhered to the recommendations of the National Committee for Clinical Laboratory Standards was applied to study the sensitivity of 22 clinical isolates of Vaginal Candida albicans to the combination therapy of fluconazole with nystatin and their in-vitro interactions. Results When fluconazole and nystatin were given in combination,there was significant reduction in the geometric mean of fluconazole MIC（ from 7.5114 μg/mL to 2.4162 μg/mL） and nystatin MIC （ from 2. 0640 μg/mL to 0. 6297 μg/mL）. For 27.3% （6/22） of the isolates the interactions were synergistic, for 72.7% （16/22） was additive, and none of them was indifferent, while antagonism was not observed. Determination of cfu/mL was performed with one isolate which was tested by one drug and different concentration combination of two drugs. For all combination,the reduction in cfu was significant greater than that observed with single drugs alone. Conclusion The combination of fluconazole and nystatin can produce synergism and/or addition in vaginal strains of Candida albicans in vitro.