本文報告一 55 歲男性病患,入院被診斷為侵入性麴菌症(aspergillosis),開始使用抗黴菌劑 caspofungin 治療 14 天,臨床症狀改善後以 itraconazole 作為維持治療。藉由此案例,藥師從藥物經濟學、藥效學及台灣健康保險藥物給付標準的角度探討 caspofungin 是否適合作為侵入性麴菌症治療的首選藥物,並建議醫師考慮使用較低價位且研究証實對侵入性麴菌症有效的藥物 voriconazole。同時,藉由此案例回顧各種抗黴菌藥物在治療侵入性麴菌症上的定位,突顯藥師執行判斷性服務在藥物經濟學上的效益,進而達到對病患全方位的藥事照顧。

     A 55-year-old man was admitted to the hospital because of invasive aspergillosis. Caspofungin was initiated and within 14 days the clinical findings improved. Caspofungin was replaced with itraconazole as maintenance therapy. Pharmacoeconomic efficacy, pharmacodynamic and health insurance of Republic of China are all taken into consideration whether caspofungin is the first choice for invasive aspergillosis. Voriconazole was recommended by a pharmacist in place of caspofungin as the first choice of invasive aspergillosis because of its cost effectiveness. Besides, clinical trial confirmed its efficacy. The places of different antifungal agents in invasive aspergillosis are also reviewed through this article. We hope that pharmacists could provide pharmaceutical care, cognitive service and improve pharmacoeconomic efficiency at the same time.