Nagai H, Shishido H, Yoneda R, Yamaguchi E, Tamura A, Kurashima A
Department of Respiratory Diseases, Tokyo National Chest Hospital, Japan.
Respiration. 1991;58(3-4):145-9. doi: 10.1159/000195915.
Although diffuse panbronchiolitis (DPB) has carried a poor prognosis, long-term low-dose administration of erythromycin (EM) is very effective. We administered EM at a daily dose of 400-600 mg to 19 DPB subjects for more than 2 months. Sixteen subjects were relieved from productive cough and dyspnea, and their chest X-ray pictures were improved. We performed a pharmacokinetic study of EM in 11 DPB subjects (8 responders; 3 nonresponders) after the long-term low-dose administration. The maximal serum and sputum levels of EM were below the MICs of clinically pathogenic H. influenzae and P. aeruginosa which were often isolated from the sputum of DPB patients. No difference was observed in the absorption of EM between responders and nonresponders. The results suggested that DPB patients might respond favorably to EM due to mechanisms other than antibacterial activity. Individual variation in the absorption of EM was observed. As EM was effective at very low serum and sputum levels, it was suggested that even 200 mg/day of EM would be effective in DPB patients who had high serum and sputum EM levels and it was necessary to monitor the concentrations of EM in serum and sputum for the treatment of DPB to determine the appropriate dose of EM individually.
尽管弥漫性泛细支气管炎（DPB）预后较差，但长期小剂量服用红霉素（EM）却非常有效。我们对19例DPB患者每日服用400 - 600毫克EM，持续2个月以上。16例患者的咳痰和呼吸困难症状得到缓解，胸部X光片也有所改善。在长期小剂量给药后，我们对11例DPB患者（8例有反应者；3例无反应者）进行了EM的药代动力学研究。EM的血清和痰液最大浓度低于临床致病流感嗜血杆菌和铜绿假单胞菌的最低抑菌浓度，这些细菌常从DPB患者痰液中分离出来。有反应者和无反应者在EM吸收方面未观察到差异。结果表明，DPB患者对EM产生良好反应的原因可能并非抗菌活性机制。观察到EM吸收存在个体差异。由于EM在极低的血清和痰液浓度下就有效，因此建议对于血清和痰液中EM浓度较高的DPB患者，即使每日200毫克的EM也可能有效，并且在DPB治疗中监测血清和痰液中EM的浓度以个体化确定合适的EM剂量是必要的。
