比较克拉霉素或阿奇霉素与阿米卡星联合应用对细胞内分枝杆菌的体外协同作用。

Comparison of in vitro synergistic effect between clarithromycin or azithromycin in combination with amikacin against Mycobacterium intracellulare.

机构信息

Respiratory Diseases Department of Nanlou, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China.

Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China.

出版信息

J Glob Antimicrob Resist. 2019 Sep;18:183-186. doi: 10.1016/j.jgar.2019.03.017. Epub 2019 Apr 3.

DOI:10.1016/j.jgar.2019.03.017

PMID:30953831

Abstract

OBJECTIVES

This study compared the in vitro synergistic effect between clarithromycin or azithromycin in combination with amikacin against Mycobacterium intracellulare.

METHODS

In vitro antimicrobial susceptibility of M. intracellulare isolates was determined by the broth microdilution method in cation-adjusted Mueller-Hinton broth. The fractional inhibitory concentration index (FICI) was also calculated to assess synergy between the antimicrobial agents.

RESULTS

A total of 32 respiratory M. intracellulare isolates were included in the study. Clarithromycin was the most potent agent against M. intracellulare, with MIC and MIC values (minimum inhibitory concentration required to inhibit 50% and 90% of the isolates, respectively) of 0.5μg/mL and 8μg/mL, respectively. Azithromycin and amikacin also showed moderate activity against M. intracellulare, with MIC values of 16μg/mL and 4μg/mL, respectively. The percentage of resistant strains among the 32 M. intracellulare isolates was 3.1% for clarithromycin, 9.3% for amikacin and 12.5% for azithromycin. The presence of amikacin had no effect on the MIC of clarithromycin, whereas the presence of amikacin resulted in a two-fold increase in the MIC of azithromycin. In addition, antagonism for the clarithromycin-amikacin combination was noted in 5 (15.6%) of the 32 M. intracellulare isolates, which was significantly lower than for the azithromycin-amikacin combination (14/32; 43.8%) (P = 0.042).

CONCLUSION

These data demonstrated that clarithromycin displayed more potent in vitro activity against M. intracellulare isolates than azithromycin. In addition, the antagonistic effect between azithromycin and amikacin was more frequent in M. intracellular isolates than that between clarithromycin and amikacin.

摘要

目的

本研究比较了克拉霉素或阿奇霉素与阿米卡星联合应用对细胞内分枝杆菌的体外协同作用。

方法

采用肉汤微量稀释法，在阳离子调整的 Mueller-Hinton 肉汤中测定细胞内分枝杆菌分离株的体外抗菌药敏性。还计算了部分抑菌浓度指数（FICI），以评估抗菌药物之间的协同作用。

结果

本研究共纳入 32 株呼吸道细胞内分枝杆菌分离株。克拉霉素对细胞内分枝杆菌最有效，其 MIC 和 MIC 值（分别为抑制 50%和 90%分离株所需的最低抑菌浓度）分别为 0.5μg/ml 和 8μg/ml。阿奇霉素和阿米卡星对细胞内分枝杆菌也表现出中度活性，其 MIC 值分别为 16μg/ml 和 4μg/ml。32 株细胞内分枝杆菌分离株中，克拉霉素耐药株的比例为 3.1%，阿米卡星耐药株的比例为 9.3%，阿奇霉素耐药株的比例为 12.5%。阿米卡宁可使克拉霉素的 MIC 无变化，而阿米卡宁可使阿奇霉素的 MIC 增加两倍。此外，在 32 株细胞内分枝杆菌分离株中，有 5 株（15.6%）出现克拉霉素-阿米卡星联合用药的拮抗作用，明显低于阿奇霉素-阿米卡星联合用药（14/32；43.8%）（P=0.042）。