Chaowagul W, Simpson A J, Suputtamongkol Y, Smith M D, Angus B J, White N J
Department of Medicine, Sappasitprasong Hospital, Ubon Ratchathani, Thailand.
Clin Infect Dis. 1999 Aug;29(2):375-80. doi: 10.1086/520218.
A prospective, open, randomized, comparative treatment trial was conducted to compare the therapeutic efficacy of the conventional four-drug combination (chloramphenicol, trimethoprim-sulfamethoxazole, and doxycycline) with that of doxycycline alone in oral maintenance treatment of melioidosis. Adult Thai patients with culture-confirmed melioidosis were randomized to receive treatment with either regimen for a minimum of 12 weeks, usually following intravenous treatment of severe disease. The main outcome measure was culture-confirmed relapse. One hundred sixteen patients were enrolled; 109 had culture-confirmed melioidosis, and 87 were considered evaluable (43 had received doxycycline). Culture-confirmed relapse occurred in one patient randomized to the conventional regimen and in 11 (25.6%) randomized to the doxycycline regimen (P = .009), and treatment failed for 8 (18.2%) versus 20 (46.5%), respectively (P = .009). Adverse effects occurred in 26% of patients overall. Doxycycline alone cannot be recommended for a first-line regimen of oral maintenance treatment of melioidosis.
开展了一项前瞻性、开放性、随机对照治疗试验，比较传统四联药物组合（氯霉素、甲氧苄啶 - 磺胺甲恶唑和强力霉素）与单独使用强力霉素在类鼻疽口服维持治疗中的疗效。经培养确诊为类鼻疽的成年泰国患者被随机分配接受上述任一治疗方案，治疗至少12周，通常在重症疾病进行静脉治疗后开始。主要结局指标为培养确诊的复发情况。共纳入116例患者；109例经培养确诊为类鼻疽，87例被视为可评估对象（43例接受了强力霉素治疗）。随机分配至传统治疗方案组的1例患者出现培养确诊的复发，随机分配至强力霉素治疗方案组的11例患者出现复发（25.6%）（P = 0.009），治疗失败率分别为8例（18.2%）和20例（46.5%）（P = 0.009）。总体而言，26%的患者出现了不良反应。不推荐单独使用强力霉素作为类鼻疽口服维持治疗的一线方案。
