Craft J C, Notario G F, Grosset J H, Heifets L B
Abbott Laboratories, North Chicago, Illinois, USA.
Clin Infect Dis. 1998 Oct;27(4):807-12. doi: 10.1086/514961.
A randomized, placebo-controlled trial was conducted to evaluate the efficacy of clarithromycin in the prevention of disseminated Mycobacterium avium complex (MAC) infection in patients with AIDS; special attention was given to the development of clarithromycin resistance. The median time to documented MAC bacteremia was 199 days for placebo-treated patients, 217 days for clarithromycin-treated patients infected with clarithromycin-susceptible MAC, and 385 days for clarithromycin-treated patients infected with clarithromycin-resistant MAC. Most of the patients with clarithromycin-resistant isolates (91%) had a baseline CD4 T-cell count of < 20/microL, while these low counts occurred in only 25% of patients having clarithromycin-susceptible breakthrough isolates. The emergence of clarithromycin resistance did not affect the total period of survival. Resistance to clarithromycin in breakthrough MAC isolates emerges most likely when the patient is extremely immunodeficient at the time of initiation of the preventative therapy.
进行了一项随机、安慰剂对照试验，以评估克拉霉素在预防艾滋病患者播散性鸟分枝杆菌复合体（MAC）感染中的疗效；特别关注了克拉霉素耐药性的产生。安慰剂治疗患者出现有记录的MAC菌血症的中位时间为199天，克拉霉素治疗的对克拉霉素敏感的MAC感染患者为217天，克拉霉素治疗的对克拉霉素耐药的MAC感染患者为385天。大多数分离出克拉霉素耐药菌株的患者（91%）基线CD4 T细胞计数<20/μL，而在仅有25%的出现克拉霉素敏感突破性菌株的患者中出现了这些低计数情况。克拉霉素耐药性的出现并不影响总生存期。当患者在开始预防性治疗时免疫极度低下时，突破性MAC菌株中最有可能出现对克拉霉素的耐药性。
