Brook Itzhak, Hausfeld Jeffrey N
Department of Pediatrics and Medicine, Georgetown University School of Medicine, Washington, DC, USA.
Arch Otolaryngol Head Neck Surg. 2006 Apr;132(4):442-5. doi: 10.1001/archotol.132.4.442.
To explore the efficacy of the ketolide telithromycin compared with azithromycin in eradicating S pneumoniae from the nasopharynx of adults with acute maxillary sinusitis. The growing resistance of Streptococcus pneumoniae to penicillin and macrolides brought about the development of a new class of antibiotics-the ketolides-that are effective against resistant pneumococci.
Otolaryngology clinic.
One-hundred five patients with acute maxillary sinusitis.
Nasopharyngeal cultures were obtained before therapy and 10 to 12 days after initiation of treatment. Fifty-nine patients were treated with 500 mg of azithromycin daily for 3 days and 46 were treated with 800 mg of telithromycin daily for 5 days.
Sixty-seven potential pathogens were recovered prior to initiation of therapy in 57 patients, 32 treated with telithromycin and 25 treated with azithromycin: S pneumoniae (31 isolates), Haemophilus influenzae (non-type b) (13), Staphylococcus aureus (8), Streptococcus pyogenes (8), and Moraxella catarrhalis (7). The distribution of the pathogens was similar in both groups. The number of S pneumoniae isolates in the azithromycin group was reduced following treatment from 14 to 8 (43% reduction), and 5 of these 8 isolates were resistant to azithromycin. In contrast, the number of S pneumoniae isolates in the telithromycin group was reduced following treatment from 17 to 1 (94% reduction) (P < .01). This isolate was susceptible to azithromycin and telithromycin. No differences were noted in the eradication rate of all of the other potential pathogens, which were all susceptible to both azithromycin and telithromycin. Development of resistance to the antimicrobial agents used (defined as increase in the minimal inhibitory concentration by at least 2 tubes) was found only in 5 isolates (4 S pneumoniae and 1 H influenzae) recovered only from patients who received azithromycin (P < .05).
These data illustrate the superiority of telithromycin to azithromycin in the eradication of S pneumoniae from the nasopharynx.
探讨酮内酯类药物泰利霉素与阿奇霉素相比，在清除成人急性上颌窦炎患者鼻咽部肺炎链球菌方面的疗效。肺炎链球菌对青霉素和大环内酯类药物的耐药性不断增加，促使了一类新型抗生素——酮内酯类药物的研发，这类药物对耐药肺炎球菌有效。
耳鼻喉科诊所。
105例急性上颌窦炎患者。
在治疗前及开始治疗10至12天后采集鼻咽部培养样本。59例患者每日服用500毫克阿奇霉素，共3天；46例患者每日服用800毫克泰利霉素，共5天。
在57例患者中，治疗开始前共分离出67种潜在病原体，其中32例接受泰利霉素治疗，25例接受阿奇霉素治疗：肺炎链球菌（31株）、流感嗜血杆菌（非b型）（13株）、金黄色葡萄球菌（8株）、化脓性链球菌（8株）和卡他莫拉菌（7株）。两组病原体分布相似。阿奇霉素组治疗后肺炎链球菌分离株数量从14株降至8株（减少43%），这8株中有5株对阿奇霉素耐药。相比之下，泰利霉素组治疗后肺炎链球菌分离株数量从17株降至1株（减少94%）（P < 0.01）。该分离株对阿奇霉素和泰利霉素均敏感。在所有其他潜在病原体的清除率方面未发现差异，这些病原体对阿奇霉素和泰利霉素均敏感。仅在接受阿奇霉素治疗的患者分离出的5株菌株（4株肺炎链球菌和1株流感嗜血杆菌）中发现对所用抗菌药物产生耐药性（定义为最低抑菌浓度至少增加2管）（P < 0.05）。
这些数据表明，在清除鼻咽部肺炎链球菌方面，泰利霉素优于阿奇霉素。
