Avery R K, Salman S D, Baker A S
Infectious Disease Unit, Massachusetts General Hospital, Boston 02114, USA.
Laryngoscope. 1995 Aug;105(8 Pt 1):854-6. doi: 10.1288/00005537-199508000-00016.
Rhinoscleroma, a chronic progressive infection of the nose and associated structures caused by Klebsiella rhinoscleromatis, has posed a therapeutic dilemma since its identification in the late 1800s. Although a number of antibiotics have been found to be effective in this relapsing disorder, the lengthy duration of treatment can lead to problems with adverse effects and compliance, especially with the traditional therapies of streptomycin and tetracycline. We report on a patient with extensive nasal rhinoscleroma who achieved pathologic and bacteriologic resolution during treatment with oral ciprofloxacin after previous courses of tetracycline and trimethoprim-sulfamethoxazole. Ciprofloxacin may prove to be useful in the therapy of rhinoscleroma because it is convenient for oral administration, achieves good tissue levels, is concentrated in macrophages, and is generally well tolerated as long-term therapy. As mentioned in a recent review of patients with rhinoscleroma at the Mayo Clinic, the fluoroquinolones deserve further study as potentially highly effective agents for this uncommon but significant infectious condition.
鼻硬结病是一种由鼻硬结克雷伯菌引起的鼻子及相关结构的慢性进行性感染，自19世纪末被发现以来一直存在治疗难题。尽管已发现多种抗生素对这种复发性疾病有效，但治疗疗程长会导致不良反应和依从性问题，尤其是使用链霉素和四环素等传统疗法时。我们报告了一名患有广泛性鼻硬结病的患者，在先前使用四环素和甲氧苄啶-磺胺甲恶唑治疗后，口服环丙沙星治疗期间实现了病理和细菌学缓解。环丙沙星可能在鼻硬结病治疗中有用，因为它便于口服给药，能达到良好的组织浓度，在巨噬细胞中富集，并且作为长期治疗一般耐受性良好。正如最近梅奥诊所对鼻硬结病患者的综述中所提到的，氟喹诺酮类药物作为治疗这种罕见但严重感染性疾病的潜在高效药物值得进一步研究。
