Hughes W T, Killmar J T, Oz H S
Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 38101.
J Infect Dis. 1994 Oct;170(4):906-11. doi: 10.1093/infdis/170.4.906.
Several drugs have been shown to have anti-Pneumocystis carinii activity in clinical trials. Because of the large number of patients required, no more than 3 drugs can be compared for efficacy in human studies. However, the experimental animal model for P. carinii pneumonitis is remarkably similar to the human disease and was used to compare 10 drugs for the relative potency against this infection. All drugs were compared at doses known to prevent the pneumonitis in > 80% of animals and at one-tenth of this dose. Drugs effective at the lowest dose were further tested at one-hundredth the original doses, and drugs ineffective were retested at 10 and 100 times the original dose. Trimethoprim-sulfamethoxazole was the most effective drug, with azithromycin-sulfamethoxazole and clarithromycin-sulfamethoxazole next most effective. Intravenous pentamidine and clindamycin-primaquine were the least effective. Atovaquone, sulfadoxine-pyrimethamine, erythromycin-sulfisoxazole, PS-15, and dapsone-trimethoprim had intermediate activity.
在临床试验中，已有数种药物显示出抗卡氏肺孢子菌的活性。由于人体研究需要大量患者，因此在人体研究中比较疗效的药物不超过3种。然而，卡氏肺孢子菌肺炎的实验动物模型与人类疾病非常相似，被用于比较10种药物对这种感染的相对效力。所有药物均在已知能预防80%以上动物发生肺炎的剂量以及该剂量的十分之一下进行比较。在最低剂量有效的药物进一步在原剂量的百分之一下进行测试，无效的药物则在原剂量的10倍和100倍下重新测试。甲氧苄啶-磺胺甲恶唑是最有效的药物，其次是阿奇霉素-磺胺甲恶唑和克拉霉素-磺胺甲恶唑。静脉注射喷他脒和克林霉素-伯氨喹最无效。阿托伐醌、周效磺胺-乙胺嘧啶、红霉素-磺胺异恶唑、PS-15和氨苯砜-甲氧苄啶具有中等活性。
