Yew W W, Chau C H
Tuberculosis & Chest Unit, Grantham Hospital, Hong Kong.
Monaldi Arch Chest Dis. 1996 Oct;51(5):394-404.
The resurgence of tuberculosis and the increased prevalence of atypical mycobacterial infections in immunocompromised subjects have prompted the quest for novel antimycobacterial agents. Fluoroquinolones, such as ofloxacin and ciprofloxacin, might be promising agents for treatment of tuberculosis especially multidrug-resistant tuberculosis (MDR-TB) and infections caused by Mycobacterium fortuitum. Clarithromycin, an important member of the macrolides, has been shown to have activity against some infections due to Mycobacterium avium-intracellulare, M. fortuitum and Mycobacterium chelonae. Rifabutin, being a rifamycin, has been found to be efficacious in treatment of drug-susceptible tuberculosis, although its place in MDR-TB is less certain. Rifabutin in combination with other drugs might constitute active regimens for treatment of disseminated M. avium-intracellulare infections. When used alone, it can be an active prophylactic agent against such infection. Imipenem, a carbapenem, might provide promising treatment for some M. fortuitum and M. chelonae infections. The place of beta-lactam-beta-lactamase inhibitor combinations in the treatment of MDR-TB is uncertain. Clofazimine and aminosidine being riminophenazine and aminoglycoside, respectively, might merit further evaluation as potentially useful agents for treatment of MDR-TB and M. avium-intracellulare infections. However, much broader evaluation of all these agents in clinical settings is still definitely required.
结核病的再度流行以及免疫功能低下人群中非典型分枝杆菌感染患病率的上升，促使人们寻求新型抗分枝杆菌药物。氟喹诺酮类药物，如氧氟沙星和环丙沙星，可能是治疗结核病尤其是耐多药结核病（MDR-TB）以及偶然分枝杆菌感染的有前景的药物。克拉霉素是大环内酯类的重要成员，已显示对鸟分枝杆菌-胞内分枝杆菌、偶然分枝杆菌和龟分枝杆菌引起的一些感染有活性。利福布汀作为一种利福霉素，已被发现对药物敏感结核病有效，尽管其在耐多药结核病中的地位尚不确定。利福布汀与其他药物联合可能构成治疗播散性鸟分枝杆菌-胞内分枝杆菌感染的有效方案。单独使用时，它可以作为预防此类感染的有效药物。亚胺培南作为一种碳青霉烯类药物，可能为一些偶然分枝杆菌和龟分枝杆菌感染提供有前景的治疗方法。β-内酰胺-β-内酰胺酶抑制剂组合在耐多药结核病治疗中的地位尚不确定。氯法齐明和氨苯砜分别作为吩嗪类和氨基糖苷类药物，可能值得进一步评估作为治疗耐多药结核病和鸟分枝杆菌-胞内分枝杆菌感染的潜在有用药物。然而，在临床环境中对所有这些药物进行更广泛的评估仍然是绝对必要的。
