Department of Pharmacy, Tian-Sheng Memorial Hospital, Tong-Kang, Ping-Tong County, Taiwan, Republic of China.
Int J Tuberc Lung Dis. 2010 Jul;14(7):806-18.
To compare the effects of food and antacids on the bioavailability of first-line anti-tuberculosis drugs.
Systematic search of electronic databases PubMed (January 1950-May 2009), and the Cochrane Library database (January 1974-May 2009), including the Cochrane Centre register of controlled trials, and ongoing trials from research registers using key terms 'food', 'antacids', 'meal', 'controlled trial', 'diet', and the first-line anti-tuberculosis drugs isoniazid (INH), rifampicin (RMP), ethambutol (EMB) and pyrazinamide (PZA). Meta-analysis was performed using RevMan software 5 to assess the impact of food or antacids on the maximum plasma concentrations (C(max)) and area under the plasma concentration time curve (AUC) of anti-tuberculosis drugs.
Twelve trials involving 157 patients were included in the meta-analysis. The overall effects showed that food significantly reduced the C(max) mean difference (C(max) MD; C(max) MD -1.42, 95%CI -1.56--1.28, P < 0.00001) and AUC (C(max) MD -3.33, 95%CI -4.05--2.62, P < 0.00001) of INH but antacids did not. Food also significantly reduced the C(max) MD (C(max) MD -2.47, 95%CI -3.30--1.64, P < 0.00001) but not the AUC of RMP. Antacids had no effect on the C(max) MD or AUC of RMP. The C(max) and AUC of PZA were unaffected by both food and antacids. Both food and antacids reduced the C(max) but not the AUC of EMB.
From a pharmacokinetic point of view, it seems that the better option for patients with gastrointestinal upsets during chemotherapy would be to add antacids rather than dosing with meals.
比较食物和抗酸剂对一线抗结核药物生物利用度的影响。
系统检索电子数据库 PubMed（1950 年 1 月至 2009 年 5 月）和 Cochrane 图书馆数据库（1974 年 1 月至 2009 年 5 月），包括 Cochrane 中心对照试验注册库和研究注册库中使用的关键词“食物”、“抗酸剂”、“膳食”、“对照试验”、“饮食”以及一线抗结核药物异烟肼（INH）、利福平（RMP）、乙胺丁醇（EMB）和吡嗪酰胺（PZA）。采用 RevMan 软件 5 进行荟萃分析，以评估食物或抗酸剂对结核药物最大血药浓度（C(max)）和血药浓度时间曲线下面积（AUC）的影响。
纳入 12 项涉及 157 例患者的试验进行荟萃分析。总体结果表明，食物显著降低了 INH 的 C(max)均值差（C(max)MD；C(max)MD -1.42，95%CI -1.56--1.28，P < 0.00001）和 AUC（C(max)MD -3.33，95%CI -4.05--2.62，P < 0.00001），但抗酸剂无此作用。食物也显著降低了 RMP 的 C(max)MD（C(max)MD -2.47，95%CI -3.30--1.64，P < 0.00001），但对其 AUC 无影响。抗酸剂对 RMP 的 C(max)MD 或 AUC 均无影响。食物和抗酸剂均不影响 PZA 的 C(max)和 AUC。食物和抗酸剂均降低了 EMB 的 C(max)，但不影响其 AUC。
从药代动力学角度来看，对于化疗期间出现胃肠道不适的患者，添加抗酸剂似乎比随餐服用更好。
