1 Division of Respiratory Medicine and Translational Medicine, and.
2 Division of Respirology and Keenan Research Centre of Li Ka Shing Knowledge Institute, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Ann Am Thorac Soc. 2019 Jul;16(7):861-867. doi: 10.1513/AnnalsATS.201811-774OC.
Intravenous tobramycin is frequently used to treat pulmonary exacerbations (PExs) in patients with cystic fibrosis (CF), but there is concern that azithromycin may interact with tobramycin, making it less effective against . The objective of this study was to determine whether oral azithromycin use was associated with worse lung function response to intravenous tobramycin treatment for PExs in a cohort of pediatric patients with CF with chronic infection. Pediatric patients from the Toronto CF database were included if they had at least one PEx and had chronic infection. Response to treatment was defined as change in forced expiratory volume in 1 second (FEV) from start to end of treatment as well as recovery of FEV to greater than or equal to 90% of baseline (best FEV in the previous 6 mo). Response to treatment was compared between patients who had received chronic azithromycin (azithromycin users) and those who had not (azithromycin nonusers), using marginal structural modeling to account for baseline FEV as both a confounder and mediator. There were 67 exacerbations (33 patients). Overall, 69% of azithromycin users and 61% of azithromycin nonusers returned to greater than or equal to 90% of baseline FEV. However, after taking into account that azithromycin users had worse baseline FEV than azithromycin nonusers, relative improvement in FEV was 9.5% (95% confidence interval, -18.7 to -0.3) lower in azithromycin users than azithromycin nonusers. Although a similar proportion of children with CF with chronic infection on azithromycin recovered lung function compared with those not on azithromycin, when we consider these patients are sicker, azithromycin use was associated with less improvement in relative (but not absolute) FEV in patients treated with intravenous tobramycin for PExs.
静脉注射妥布霉素常用于治疗囊性纤维化（CF）患者的肺部恶化（PEx），但人们担心阿奇霉素可能与妥布霉素相互作用，使其对 的疗效降低。本研究的目的是确定在患有慢性 感染的 CF 儿科患者队列中，口服阿奇霉素的使用是否与静脉注射妥布霉素治疗 PEx 的肺功能反应较差相关。如果患者至少有一次 PEx 且患有慢性 感染，则将多伦多 CF 数据库中的儿科患者纳入研究。治疗反应定义为从治疗开始到结束时用力呼气量（FEV）的变化，以及 FEV 恢复到大于或等于基线的 90%（过去 6 个月中最佳 FEV）。使用边缘结构模型来考虑基线 FEV 作为混杂因素和中介因素，比较接受慢性阿奇霉素治疗的患者（阿奇霉素使用者）和未接受治疗的患者（阿奇霉素非使用者）之间的治疗反应。共有 67 次恶化（33 名患者）。总体而言，69%的阿奇霉素使用者和 61%的阿奇霉素非使用者的 FEV 恢复到大于或等于基线的 90%。然而，在考虑到阿奇霉素使用者的基线 FEV 比阿奇霉素非使用者差后，阿奇霉素使用者的 FEV 相对改善比阿奇霉素非使用者低 9.5%（95%置信区间，-18.7 至-0.3）。尽管接受慢性 感染阿奇霉素治疗的 CF 患儿与未接受阿奇霉素治疗的患儿相比，有相同比例的患儿恢复了肺功能，但当我们考虑到这些患儿病情更严重时，阿奇霉素的使用与静脉注射妥布霉素治疗 PEx 患者的相对（但不是绝对）FEV 改善减少相关。
