Division of Infection, Barts Healthcare NHS Trust, London, UK These authors contributed equally to this work.
Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari - Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy These authors contributed equally to this work.
Eur Respir J. 2016 Jun;47(6):1758-66. doi: 10.1183/13993003.00214-2016. Epub 2016 Apr 13.
No large study to date has ever evaluated the effectiveness, safety and tolerability of imipenem/clavulanate versus meropenem/clavulanate to treat multidrug- and extensively drug-resistant tuberculosis (MDR- and XDR-TB). The aim of this observational study was to compare the therapeutic contribution of imipenem/clavulanate versus meropenem/clavulanate added to background regimens to treat MDR- and XDR-TB cases.84 patients treated with imipenem/clavulanate-containing regimens showed a similar median number of antibiotic resistances (8 versus 8) but more fluoroquinolone resistance (79.0% versus 48.9%, p<0.0001) and higher XDR-TB prevalence (67.9% versus 49.0%, p=0.01) in comparison with 96 patients exposed to meropenem/clavulanate-containing regimens. Patients were treated with imipenem/clavulanate- and meropenem/clavulanate-containing regimens for a median (interquartile range) of 187 (60-428) versus 85 (49-156) days, respectively.Statistically significant differences were observed on sputum smear and culture conversion rates (79.7% versus 94.8%, p=0.02 and 71.9% versus 94.8%, p<0.0001, respectively) and on success rates (59.7% versus 77.5%, p=0.03). Adverse events to imipenem/clavulanate and meropenem/clavulanate were reported in 5.4% and 6.5% of cases only.Our study suggests that meropenem/clavulanate is more effective than imipenem/clavulanate in treating MDR/XDR-TB patients.
迄今为止，尚无大型研究评估过亚胺培南/克拉维酸与美罗培南/克拉维酸治疗耐多药和广泛耐药结核病（MDR-TB 和 XDR-TB）的有效性、安全性和耐受性。本观察性研究旨在比较将亚胺培南/克拉维酸与美罗培南/克拉维酸添加到背景治疗方案中治疗 MDR-TB 和 XDR-TB 病例的治疗效果。84 例接受亚胺培南/克拉维酸方案治疗的患者的抗生素耐药中位数相似（8 种与 8 种），但氟喹诺酮耐药率更高（79.0%与 48.9%，p<0.0001），广泛耐药结核病的患病率更高（67.9%与 49.0%，p=0.01），而 96 例接受美罗培南/克拉维酸方案治疗的患者。接受亚胺培南/克拉维酸和美罗培南/克拉维酸方案治疗的患者的中位数（四分位距）分别为 187（60-428）和 85（49-156）天。在痰涂片和培养转换率（79.7%与 94.8%，p=0.02 和 71.9%与 94.8%，p<0.0001）和成功率（59.7%与 77.5%，p=0.03）上观察到统计学显著差异。仅报告了 5.4%和 6.5%的病例发生亚胺培南/克拉维酸和美罗培南/克拉维酸的不良反应。我们的研究表明，美罗培南/克拉维酸在治疗 MDR/XDR-TB 患者方面比亚胺培南/克拉维酸更有效。
