Kawata Noriko, Kawahara Shin, Tada Atsuhiko, Takigawa Nagio, Shibayama Takuo, Soda Ryo, Takahashi Kiyoshi
Department of Pulmonary Medicine, National Hospital Organization Minami-Okayama Medical Center, 4066, Hayashima, Hayashima-cho, Okayama 701-0304 Japan.
Kekkaku. 2006 Apr;81(4):329-35.
Recently the incidence of pulmonary nontuberculous mycobacteria infection has increased among patients not only implicated with AIDS, but also without predisposing conditions. However, an effective antimicrobial therapy for the disease has not been established yet, because of the absence of highly active therapeutic drugs. We compared the in vitro antimicrobial activities of five antituberculous drugs, clarithromycin and fluoroquinolones against 92 clinical isolates belonging to three species of slowly growing nontuberculous mycobacteria.
M. avium (31 strains), M. intracellulare (44 strains), and M. kansasii (17 strains), all of which were isolated from sputum specimens of previously untreated patients with pulmonary nontuberculous mycobacteria infection, were used. The eight agents tested were streptomycin, ethambutol, kanamycin, isoniazid, rifampicin, clarithromycin, levofloxacin and gatifloxacin. The drug susceptibility of these strains in terms of MIC (minimum inhibitory concentration) was determined by BrothMIC NTM.
The MICs of rifampicin, clarithromycin, levofloxacin and gatifloxacin for all three species were low and gatifloxacin was more active than levofloxacin between two fluoroquinolones. Regarding clarithromycin, 100% of the strains were susceptible to 2 micrograms/ml or less and none of the strains were resistant on this level. In contrast, the MICs of ethambutol and isoniazid for M. avium and M. intracellulare were high and less active in vitro than the other antimicrobial agents.
These MIC studies suggest that rifampicin, clarithromycin, levofloxacin, and gatifloxacin have excellent in vitro antimicrobial activities against M. avium, M. intracellulare and M. kansasii and especially clarithromycin may be very useful as a drug therapy for previously untreated patients. In the treatment of pulmonary nontuberculous mycobacterium infection, further studies are needed to evaluate the clinical effects of these drugs and to observe the drug resistance, on the basis of the results of the drug susceptibility test by BrothMIC NTM.
近年来，肺部非结核分枝杆菌感染的发病率不仅在艾滋病患者中有所增加，在无易感因素的患者中也有所上升。然而，由于缺乏高效的治疗药物，针对该疾病的有效抗菌治疗方法尚未确立。我们比较了五种抗结核药物、克拉霉素和氟喹诺酮类药物对92株属于三种缓慢生长非结核分枝杆菌临床分离株的体外抗菌活性。
使用从先前未经治疗的肺部非结核分枝杆菌感染患者痰液标本中分离出的鸟分枝杆菌（31株）、胞内分枝杆菌（44株）和堪萨斯分枝杆菌（17株）。所测试的八种药物为链霉素、乙胺丁醇、卡那霉素、异烟肼、利福平、克拉霉素、左氧氟沙星和加替沙星。通过肉汤微量稀释法（BrothMIC NTM）测定这些菌株的最低抑菌浓度（MIC）药敏情况。
利福平、克拉霉素、左氧氟沙星和加替沙星对所有三种分枝杆菌的MIC均较低，且在两种氟喹诺酮类药物中，加替沙星比左氧氟沙星活性更强。对于克拉霉素，100%的菌株对2微克/毫升及以下浓度敏感，在此浓度水平下无菌株耐药。相比之下，乙胺丁醇和异烟肼对鸟分枝杆菌和胞内分枝杆菌的MIC较高，且体外活性低于其他抗菌药物。
这些MIC研究表明，利福平、克拉霉素、左氧氟沙星和加替沙星对鸟分枝杆菌、胞内分枝杆菌和堪萨斯分枝杆菌具有优异的体外抗菌活性，尤其是克拉霉素可能对先前未经治疗的患者作为药物治疗非常有用。在治疗肺部非结核分枝杆菌感染时，需要根据肉汤微量稀释法（BrothMIC NTM）药敏试验结果进一步研究评估这些药物的临床疗效并观察耐药情况。
