Tsukamura M, Yamori S
Department of Microbiology, Fujita-Gakuen Health University Medical School, Aichi, Japan.
Kekkaku. 1990 May;65(5):349-57.
Treatment of nontuberculous mycobacterial infection should be carried out by the chemotherapeutic regimens most suitable for each species. We performed in-vitro susceptibility tests for various species and determined the probability in which the mycobacteria of each species are inhibited by blood concentrations attainable by the dosages usually used. From such determinations, the following regimens have been recommended: 1) M. avium-M. intracellulare complex, Rifampicin + Enviomycin + Ethambutol; 2) M. kansasii, Ofloxacin + Enviomycin + Rifampicin; 3) M. szulgai, Enviomycin - Ethambutol + Isoniazid; 4) M. fortuitum, Ofloxacin. The effectiveness of the treatment of the infection caused by M. avium complex is less than 15% even using the above regimen, while it is high in the treatment of infections caused by M. kansasii and M. szulgai. There are no effective regimens for the treatment of infection caused by M. chelonae or M. simiae. The above recommendations are useful in practice, because, at present, reliable susceptibility testing of nontuberculous mycobacteria is not yet done commonly.
非结核分枝杆菌感染的治疗应采用最适合每种菌的化疗方案。我们对各种菌进行了体外药敏试验,并确定了通常使用剂量所能达到的血药浓度抑制每种菌的概率。根据这些测定结果,推荐了以下方案:1)鸟分枝杆菌-胞内分枝杆菌复合群,利福平+卷曲霉素+乙胺丁醇;2)堪萨斯分枝杆菌,氧氟沙星+卷曲霉素+利福平;3)苏尔加分枝杆菌,卷曲霉素-乙胺丁醇+异烟肼;4)偶然分枝杆菌,氧氟沙星。即使采用上述方案,鸟分枝杆菌复合群引起的感染治疗有效率仍低于15%,而对堪萨斯分枝杆菌和苏尔加分枝杆菌引起的感染治疗有效率较高。目前尚无治疗龟分枝杆菌或猿分枝杆菌感染的有效方案。上述建议在实际应用中很有用,因为目前非结核分枝杆菌的可靠药敏试验尚未普遍开展。