Dubé M P, Sattler F R, Torriani F J, See D, Havlir D V, Kemper C A, Dezfuli M G, Bozzette S A, Bartok A E, Leedom J M, Tilles J G, McCutchan J A
University of Southern California School of Medicine, Los Angeles, USA.
J Infect Dis. 1997 Nov;176(5):1225-32. doi: 10.1086/514116.
Patients with AIDS and Mycobacterium avium complex (MAC) bacteremia are at high risk for relapse and emergence of resistant isolates during monotherapy with clarithromycin. Ninety-five AIDS patients with MAC bacteremia received clarithromycin plus clofazimine, with or without ethambutol, in a prospective, multicenter, randomized open-label trial. Of 80 patients with positive baseline cultures, sterilization or a 2 log10 reduction in colony-forming units of MAC in two consecutive blood cultures occurred in 69% of both groups. There were nine relapses in the two-drug arm and three in the three-drug arm. Kaplan-Meier estimates of risk of relapse at 36 weeks were 68% and 12%, respectively (P = .004). All relapse isolates were resistant to clarithromycin. Median time to clarithromycin resistance was 16 weeks with two drugs and 40 weeks with three drugs (P = .004). Ethambutol reduced relapses and emergence of clarithromycin resistance and should be considered an essential component of clarithromycin-based therapies for MAC bacteremia.
患有艾滋病和鸟分枝杆菌复合体（MAC）菌血症的患者在接受克拉霉素单药治疗期间，复发和出现耐药菌株的风险很高。在一项前瞻性、多中心、随机开放标签试验中，95例患有MAC菌血症的艾滋病患者接受了克拉霉素加氯法齐明治疗，部分患者联合或未联合乙胺丁醇。在80例基线培养阳性的患者中，两组中69%的患者在连续两次血培养中出现MAC菌落形成单位的杀菌或降低2个对数10。两药组有9例复发，三药组有3例复发。36周时复发风险的Kaplan-Meier估计分别为68%和12%（P = .004）。所有复发菌株均对克拉霉素耐药。出现克拉霉素耐药的中位时间，两药治疗为16周，三药治疗为40周（P = .004）。乙胺丁醇可减少复发和克拉霉素耐药的出现，应被视为基于克拉霉素的MAC菌血症治疗的重要组成部分。
