Durek C, Rüsch-Gerdes S, Jocham D, Böhle A
Department of Urology, Medical University of Lübeck, Germany.
J Urol. 1999 Dec;162(6):1959-62. doi: 10.1016/S0022-5347(05)68078-0.
We determine the effects of modern antibacterial chemotherapeutics on bacillus Calmette-Guerin (BCG) viability, particularly those of cycloserine, which has been recommended for treating BCG induced sepsis.
The minimal inhibitory concentrations of 31 antibacterial drugs against Connaught BCG strain were determined in vitro by the radiometric BACTEC 460TB method. Minimal inhibitory concentrations were compared with the drug concentrations achievable in blood and urine to estimate systemic or intravesical susceptibility. Susceptibility testing of cycloserine was performed with Connaught, Tice and RIVM BCG strains, using the modified proportion method on Lowenstein-Jensen agar.
Connaught BCG was susceptible to quinolones in systemic infections but resistant to beta-lactams, macrolides and some aminoglycosides. It was resistant to pyrazinamide but showed good susceptibility toward the other antituberculosis drugs tested. All 3 BCG strains analyzed were resistant to cycloserine. Most antibacterials may interfere with BCG in the bladder because of high urinary recovery.
Antibacterial drug interference with BCG viability should be avoided during intravesical instillation therapy. In cases of severe complications quinolones rather than cycloserine may be given in addition to standard triple antituberculosis drug therapy or if one of these drugs is not tolerated. Our data may contribute toward enhancing the therapeutic safety and efficacy of intravesical BCG immunotherapy by the appropriate use of antibacterial drugs.
我们确定现代抗菌化疗药物对卡介苗（BCG）活力的影响，尤其是环丝氨酸的影响，环丝氨酸已被推荐用于治疗卡介苗诱导的败血症。
采用放射性BACTEC 460TB方法在体外测定31种抗菌药物对康诺特卡介苗菌株的最低抑菌浓度。将最低抑菌浓度与血液和尿液中可达到的药物浓度进行比较，以评估全身或膀胱内的敏感性。使用改良比例法在罗-琴培养基上对康诺特、蒂策和荷兰国家公共卫生与环境研究所卡介苗菌株进行环丝氨酸敏感性试验。
康诺特卡介苗在全身感染中对喹诺酮类敏感，但对β-内酰胺类、大环内酯类和一些氨基糖苷类耐药。它对吡嗪酰胺耐药，但对其他测试的抗结核药物表现出良好的敏感性。分析的所有3种卡介苗菌株均对环丝氨酸耐药。由于尿液回收率高，大多数抗菌药物可能会在膀胱中干扰卡介苗。
在膀胱内灌注治疗期间应避免抗菌药物对卡介苗活力的干扰。在严重并发症的情况下，除标准的三联抗结核药物治疗外，或者如果不能耐受其中一种药物，可以给予喹诺酮类而非环丝氨酸。我们的数据可能有助于通过适当使用抗菌药物提高膀胱内卡介苗免疫治疗的治疗安全性和疗效。
