Chiu J, Nussbaum J, Bozzette S, Tilles J G, Young L S, Leedom J, Heseltine P N, McCutchan J A
Division of Infectious Diseases, University of California, Irvine Medical Center, Orange 92668.
Ann Intern Med. 1990 Sep 1;113(5):358-61. doi: 10.7326/0003-4819-113-5-358.
To determine the efficacy of combination drug therapy for disseminated Mycobacterium avium complex infection in patients with the acquired immunodeficiency syndrome (AIDS).
Prospective, nonrandomized, before-after comparison.
Outpatient clinics at three university medical centers.
Seventeen patients with at least two consecutive blood cultures positive for M. avium complex who had not been previously treated with antituberculous medications. Fifteen of the seventeen patients completed at least 4 weeks of treatment.
Patients received daily intravenous amikacin (7.5 mg/kg body weight) for the first 4 weeks plus the following oral medications for at least 12 weeks: ciprofloxacin, 750 mg twice daily; ethambutol, 1000 mg daily; and rifampin, 600 mg daily.
The baseline geometric mean colony count from blood cultures decreased from 537/mL to 14/mL (P less than 0.001) after 4 weeks of therapy. The microbiologic suppression was sustained while on treatment and was associated with a decrease in systemic symptoms related to M. avium complex infection. Premature withdrawal from treatment (less than 12 weeks) occurred in 7 of 17 patients. The commonest reasons for early withdrawal were gastrointestinal intolerance and hepatic toxicity.
Mycobacterial load and systemic symptoms in patients with AIDS and disseminated M. avium complex infection can be effectively reduced by a regimen containing amikacin, ethambutol, rifampin, and ciprofloxacin.
确定联合药物疗法对获得性免疫缺陷综合征（艾滋病）患者播散性鸟分枝杆菌复合群感染的疗效。
前瞻性、非随机、前后对照研究。
三家大学医学中心的门诊诊所。
17例患者，其至少连续两次血培养鸟分枝杆菌复合群阳性，且此前未接受过抗结核药物治疗。17例患者中有15例完成了至少4周的治疗。
患者在最初4周每日静脉注射阿米卡星（7.5mg/kg体重），并加用以下口服药物至少12周：环丙沙星，每日两次，每次750mg；乙胺丁醇，每日1000mg；利福平，每日600mg。
治疗4周后，血培养的基线几何平均菌落计数从537/mL降至14/mL（P<0.001）。治疗期间微生物抑制作用持续存在，并与鸟分枝杆菌复合群感染相关的全身症状减轻有关。17例患者中有7例过早停药（少于12周）。早期停药最常见的原因是胃肠道不耐受和肝毒性。
含阿米卡星、乙胺丁醇、利福平和环丙沙星的治疗方案可有效降低艾滋病合并播散性鸟分枝杆菌复合群感染患者的分枝杆菌载量和全身症状。
