Nuermberger Eric L, Yoshimatsu Tetsuyuki, Tyagi Sandeep, Williams Kathy, Rosenthal Ian, O'Brien Richard J, Vernon Andrew A, Chaisson Richard E, Bishai William R, Grosset Jacques H
Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Am J Respir Crit Care Med. 2004 Nov 15;170(10):1131-4. doi: 10.1164/rccm.200407-885OC. Epub 2004 Aug 11.
In a recent experimental study using the mouse model of tuberculosis, treatment with a combination of rifampin, moxifloxacin, and pyrazinamide was able to shorten the time to negative lung cultures by up to 2 months compared with the standard regimen of rifampin, isoniazid, and pyrazinamide. To confirm that this substitution of moxifloxacin for isoniazid permits a shorter duration of treatment, a second study was performed in which mice were assessed for relapse after treatment with combination therapy for 3, 4, 5, or 6 months. Although no relapse was observed among mice treated for at least 4 months with rifampin, moxifloxacin, and pyrazinamide, mice treated with rifampin, isoniazid, and pyrazinamide required 6 months of treatment before no relapse could be detected. For mice treated with rifampin, moxifloxacin, and pyrazinamide, similar efficacy was noted whether pyrazinamide was administered for 1 month, 2 months, or the entire duration of therapy. These results suggest that the use of rifampin, moxifloxacin, and pyrazinamide may substantially shorten the duration of therapy needed to cure human tuberculosis and that the full benefit of pyrazinamide in this regimen may be realized after just 1 month of treatment.
在最近一项使用肺结核小鼠模型的实验研究中,与利福平、异烟肼和吡嗪酰胺的标准治疗方案相比,利福平、莫西沙星和吡嗪酰胺联合治疗能够将肺部培养转阴时间最多缩短2个月。为了证实用莫西沙星替代异烟肼可缩短治疗时间,进行了第二项研究,对接受3、4、5或6个月联合治疗的小鼠进行治疗后复发情况评估。尽管用利福平、莫西沙星和吡嗪酰胺治疗至少4个月的小鼠未观察到复发,但用利福平、异烟肼和吡嗪酰胺治疗的小鼠需要6个月治疗才能检测不到复发。对于用利福平、莫西沙星和吡嗪酰胺治疗的小鼠,无论吡嗪酰胺给药1个月、2个月还是整个治疗期间,疗效相似。这些结果表明,使用利福平、莫西沙星和吡嗪酰胺可能会大幅缩短治愈人类肺结核所需的治疗时间,并且在该方案中,吡嗪酰胺仅治疗1个月后可能就会实现其全部益处。