碳青霉烯类/β-内酰胺酶抑制剂复合制剂与美罗培南/β-内酰胺酶抑制剂复合制剂治疗耐多药和广泛耐药结核病的疗效和安全性比较。
Comparison of effectiveness and safety of imipenem/clavulanate- versus meropenem/clavulanate-containing regimens in the treatment of MDR- and XDR-TB.
机构信息
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.
出版信息
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。
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