Wallace R J, Brown B A, Griffith D E, Girard W M, Murphy D T
The Center for Pulmonary Infectious Disease Control, University of Texas Health Center, Tyler, Texas 75710, USA.
Am J Respir Crit Care Med. 1996 Jun;153(6 Pt 1):1766-72. doi: 10.1164/ajrccm.153.6.8665032.
Intermediate results of the first 50 patients treated with clarithromycin (CLARI) regimens for Mycobacterium avium-intracellulare (MAI) lung disease were evaluated. Patients were HIV negative, and pretreatment isolates were susceptible to CLARI. Patients received CLARI 500 mg twice daily, ethambutol, rifampin (RMP), or rifabutin (RBT) and initial streptomycin, and they were treated until culture-negative 1 yr. Eleven of 50 patients (22%) were dropped in the first 3 mo. Of the remaining 39 patients, 36 (92%) converted their sputa to negative, and 32 (82%) remain culture negative to date. This includes 11 of 16 (69%) with prior drug therapy and 21 of 23 (91%) with no prior therapy. One or more companion drugs were discontinued in 16 of 39 (41%) of patients because of adverse events. Isolates from six of 39 patients (15%) became CLARI-resistant. Of 23 patients who are alive and were culture-negative a mean of 12.0 mo while receiving therapy, all remain culture-negative without therapy a mean of 19.1 mo. Despite reduced CLARI serum levels in patients also receiving RMP, 10 of 13 patients (77%) receiving this regimen were successfully treated. Although not directly compared with previous regimens, the success of this regimen strongly suggests it is superior to previous non-CLARI-containing regimens.
对首批50例接受克拉霉素（CLARI）方案治疗鸟分枝杆菌胞内复合群（MAI）肺病患者的中期结果进行了评估。患者为HIV阴性，治疗前分离株对CLARI敏感。患者接受每日两次500mg克拉霉素、乙胺丁醇、利福平（RMP）或利福布汀（RBT）以及初始链霉素治疗，治疗至培养阴性1年。50例患者中有11例（22%）在最初3个月内退出。其余39例患者中，36例（92%）痰菌转阴，32例（82%）至今培养仍为阴性。这包括16例中有11例（69%）曾接受过药物治疗，23例中有21例（91%）未曾接受过治疗。39例患者中有16例（41%）因不良事件停用了一种或多种辅助药物。39例患者中有6例（15%）的分离株对CLARI耐药。在23例存活且在接受治疗期间平均12.0个月培养阴性的患者中，所有患者在未接受治疗的情况下平均19.1个月培养仍为阴性。尽管同时接受RMP治疗的患者CLARI血清水平降低，但接受该方案治疗的13例患者中有10例（77%）成功治愈。虽然未与先前方案直接比较，但该方案的成功强烈表明其优于先前不含CLARI的方案。
