中国抗真菌药品应用现状及目录优化思考

Current status and considerations for optimization of antifungal drug application in China

我国侵袭性真菌感染的患病率逐年增加。然而,依据相关政策规定,医院采购抗真菌药品存在品种限制,临床目前用药品种的药理作用又相似度较高,可能导致对侵袭性真菌感染的治疗延迟。笔者总结了我国抗真菌药的适应证与临床应用现状,通过药品可及性分析,了解常见抗真菌药的药理特点及部分不可替代使用药品的局限性。基于此,认为相关部门应适当放宽抗真菌药品品种限制政策;医疗机构应定期(1~2年)调整、优化其供应目录与品种结构;同时,由于近年来国内外深部真菌病相关指南和专家共识中对伊曲康唑的推荐地位低,但在皮肤和黏膜等浅表真菌感染指南共识推荐地位较高,建议根据医疗机构真菌病病种的分布特征选择是否列入抗菌药品目录。

The incidence of invasive fungal infections in China is increasing year by year.However,due to relevant policies,hospitals face restrictions on the variety of antifungal drugs they can procure.Currently,the pharmacological effects of the clinically used antifungal drugs are highly similar,which may lead to delays in the treatment of invasive fungal infections.The authors summarized the indications and clinical application status of antifungal drugs in China,and through an analysis of drug accessibility,understood the pharmacological characteristics of common antifungal drugs and the limitations of some irreplaceable drugs.Based on this,it is believed that relevant authorities should appropriately relax the policy restrictions on the variety of antifungal drugs.Medical institutions should periodically(every 1 to 2 years)adjust and optimize their supply catalogs and variety structures.Meanwhile,due to the low recommended status of itraconazole in recent domestic and international guidelines and expert consensus on deep fungal diseases,but its relatively high recommended status in superficial fungal infection guidelines,such as skin and mucous membranes infections,it is suggested that the selection of whether to introduce an antimicrobial drug list should be based on the distribution characteristic of fungal diseases in medical institutions.