Jablonowski H, Fätkenheuer G, Youle M, Newell T, Lines S, Craft J C
Department of Gastroenterology and Infectious Diseases, Heinrich-Heine University, Düsseldorf, Germany.
Drugs. 1997;54 Suppl 2:16-22; discussion 28-9. doi: 10.2165/00003495-199700542-00005.
Because of the significant morbidity and mortality associated with opportunistic infections, prophylaxis has become routine practice in the management of immunocompromised patients such as those with AIDS. Clarithromycin, an antimicrobial agent with a broad spectrum of activity against most common respiratory pathogens as well as many protozoa, has proven to be effective for both treatment and prophylaxis of Mycobacterium avium-intracellulare complex (MAC) infection in AIDS patients. Results of a large multinational placebo-controlled study suggest that clarithromycin for MAC prophylaxis provides additional benefits. In this study, clarithromycin statistically significantly reduced the incidence of Pneumocystis carinii pneumonia (5.3% of clarithromycin recipients vs 10.0% of placebo recipients; p = 0.021), community-acquired pneumonia (7.1 vs 13.0%; p = 0.010), Giardia lamblia infection (0.9 vs 2.9%; p = 0.048), and neoplastic diseases (1.8 vs 4.1%; p = 0.010) in AIDS patients with CD4+ counts of < or = 100 cells/microliter.
由于机会性感染会导致严重的发病率和死亡率，因此预防性治疗已成为管理免疫功能低下患者（如艾滋病患者）的常规做法。克拉霉素是一种抗菌药物，对大多数常见呼吸道病原体以及许多原生动物具有广泛的活性，已被证明对艾滋病患者鸟分枝杆菌复合群（MAC）感染的治疗和预防均有效。一项大型跨国安慰剂对照研究的结果表明，克拉霉素用于MAC预防具有额外的益处。在这项研究中，克拉霉素在统计学上显著降低了卡氏肺孢子虫肺炎的发病率（克拉霉素接受者为5.3%，安慰剂接受者为10.0%；p = 0.021）、社区获得性肺炎的发病率（7.1%对13.0%；p = 0.010）、蓝氏贾第鞭毛虫感染的发病率（0.9%对2.9%；p = 0.048）以及肿瘤性疾病的发病率（1.8%对4.1%；p = 0.010），这些患者的CD4 +细胞计数≤100个/微升。
