Hall W H
Research Service (151), Veterans Affairs Medical Center, Minneapolis, Minnesota 55417.
Rev Infect Dis. 1990 Nov-Dec;12(6):1060-99. doi: 10.1093/clinids/12.6.1060.
The most effective, least toxic chemotherapy for human brucellosis is still undecided. In vitro, the antibiotics most active against Brucella include the tetracyclines, the aminoglycosides, the aminopenicillins, some cephalosporins, trimethoprim-sulfamethoxazole, erythromycin, rifampin, and some new fluorinated quinolones. Because Brucella species are facultative intracellular parasites, the penetration of drugs into and within phagocytes and phagosomes can be problematic and can best be studied in experimental animals or tissue cultures. In humans, the effectiveness of various regimens of chemotherapy has been compared best in acute bacteremic infections by assessment of the control of symptoms, bacteremia, complications, and relapses. The standard therapy against which all other therapies have been judged is a combination of tetracycline and streptomycin, which is almost universally effective but fails to prevent relapse in 10% of cases. A combination of oral doxycycline and rifampin is convenient and currently popular; it is highly effective, with an average relapse rate of only 8.4%. Trimethoprim-sulfamethoxazole is less effective in controlling bacteremia and other manifestations: in collected series, 5.7% of cases did not respond and 12% relapsed. Drug-resistant Brucella strains are rarely a cause of therapy failure. Localized brucellosis poses special problems, often requiring surgery in addition to prolonged combined chemotherapy.
治疗人类布鲁氏菌病最有效、毒性最小的化疗方案仍未确定。在体外，对布鲁氏菌活性最强的抗生素包括四环素类、氨基糖苷类、氨基青霉素类、一些头孢菌素、甲氧苄啶 - 磺胺甲恶唑、红霉素、利福平以及一些新型氟喹诺酮类。由于布鲁氏菌属是兼性细胞内寄生虫，药物进入吞噬细胞和吞噬体及其在其中的渗透可能存在问题，最好在实验动物或组织培养中进行研究。在人类中，通过评估症状、菌血症、并发症和复发的控制情况，在急性菌血症感染中能最好地比较各种化疗方案的有效性。所有其他疗法与之比较的标准疗法是四环素和链霉素联合使用，该疗法几乎普遍有效，但仍有10%的病例无法预防复发。口服强力霉素和利福平联合使用方便且目前很流行；它非常有效，平均复发率仅为8.4%。甲氧苄啶 - 磺胺甲恶唑在控制菌血症和其他表现方面效果较差：在收集的系列病例中，5.7%的病例无反应，12%复发。耐药布鲁氏菌菌株很少是治疗失败的原因。局限性布鲁氏菌病带来特殊问题，通常除了长期联合化疗外还需要手术治疗。
