Hewitt R G, Papandonatos G D, Shelton M J, Hsiao C B, Harmon B J, Kaczmarek S R, Amsterdam D
Department of Medicine, State University of New York at Buffalo, USA.
AIDS. 1999 Jul 30;13(11):1367-72. doi: 10.1097/00002030-199907300-00014.
To evaluate the ability of once daily reduced dose clarithromycin to prevent disseminated Mycobacterium avium complex (dMAC) infection in patients with advanced HIV disease.
Non-randomized, retrospective study.
Outpatient clinic of an urban university-affiliated municipal hospital.
A group of 192 HIV-infected patients with a CD4 count < 100 x 10(6) cells/l who were followed for at least 90 days during a 6-year period (1991-1996) before the use of protease inhibitors.
Clarithromycin 500 mg orally once daily (n = 84), rifabutin 300 mg orally once daily (n = 47) or no prophylaxis (n = 61).
Positive blood culture for M. avium complex (MAC), time to development of dMAC, and time to death.
When compared with no prophylaxis or rifabutin, the incidence of dMAC and time to development of dMAC were improved among those patients receiving clarithromycin (P < 0.001). Prolonged survival was associated with both clarithromycin and rifabutin use when compared with no prophylaxis (P < 0.002). In patients who failed prophylaxis, resistance to clarithromycin and rifabutin was observed.
In the era prior to protease inhibitor use, once daily clarithromycin at a dose of 500 mg was associated with a reduction in the incidence of dMAC, appeared to be superior to rifabutin, and was associated with prolonged survival in patients with advanced HIV disease.
评估每日一次低剂量克拉霉素预防晚期HIV疾病患者播散性鸟分枝杆菌复合体（dMAC）感染的能力。
非随机回顾性研究。
城市大学附属医院门诊。
一组192例HIV感染患者，其CD4细胞计数<100×10⁶个/升，在使用蛋白酶抑制剂之前的6年期间（1991 - 1996年）接受了至少90天的随访。
克拉霉素500毫克口服每日一次（n = 84），利福布汀300毫克口服每日一次（n = 47）或不进行预防（n = 61）。
鸟分枝杆菌复合体（MAC）血培养阳性、dMAC发生时间和死亡时间。
与不进行预防或使用利福布汀相比，接受克拉霉素治疗的患者中dMAC的发生率和dMAC发生时间得到改善（P < 0.001）。与不进行预防相比，使用克拉霉素和利福布汀均与生存期延长相关（P < 0.002）。在预防失败的患者中，观察到对克拉霉素和利福布汀的耐药性。
在蛋白酶抑制剂使用之前的时代，每日一次500毫克剂量的克拉霉素与dMAC发生率降低相关，似乎优于利福布汀，并且与晚期HIV疾病患者的生存期延长相关。
