The microbiological and clinical effects of combined therapy according to guidelines on the treatment of pulmonary Mycobacterium avium complex disease in Japan -: Including a follow-up study
The microbiological and clinical effects of combined therapy according to guidelines on the treatment of pulmonary Mycobacterium avium complex disease in Japan -: Including a follow-up study
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DOI：
10.1159/000095674
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发表时间：
2007-01-01
期刊：
影响因子：
3.7
通讯作者：
Matsushima, Toshiharu
中科院分区：
文献类型：
--
作者：
Kobashi, Yoshihiro;Matsushima, Toshiharu
背景：日本肺鸟分枝杆菌复合体（MAC）的治疗困难。目的：根据美国胸科学会和日本结核学会提出的治疗指南和完成肺部MAC病患者治疗后的前瞻性随访研究，探讨治疗的临床和微生物效应。方法：分析利福平、乙胺丁醇、链霉素、克拉霉素联合治疗肺MAC病患者24个月及随访12个月期间的痰转化率、痰复发率、临床症状及影像学表现方面的微生物学效应。结果：65例肺MAC疾病患者入组本试验。39例患者在开始治疗后6个月内痰转阴性，16例复发，20例在治疗结束后1年内出现临床恶化。虽然对这些患者进行了相同方案或包含新喹诺酮类药物的方案的再治疗，但我们无法实现痰阴转化和/或临床改善。结论：我们认为，可增加克拉霉素治疗肺部MAC疾病的剂量，并建议对早期MAC疾病有局限性病变的患者进行手术治疗，以防止高复发率。版权所有(C) 2006 S. Karger AG，巴塞尔
Background: The difficulty of treatment for pulmonary Mycobacterium avium complex ( MAC) in Japan. Objectives: To investigate the clinical and microbiological effects of treatment according to the guidelines proposed by the American Thoracic Society and the Japanese Society for Tuberculosis and prospective follow-up studies after the completion of treatment of patients with pulmonary MAC disease. Methods: Analysis of the microbiological effects with regard to sputum conversion rate and the sputum relapsing rate and the clinical effects with regard to clinical symptoms and radiological findings for patients with pulmonary MAC disease treated with a regimen consisting of rifampicin, ethambutol, streptomycin, and clarithromycin over 24 months and follow-up over 12 months. Results: Sixty-five patients with pulmonary MAC disease were enrolled in this trial. In 39 patients, negative sputum conversion was observed within 6 months after the initiation of this regimen, 16 relapsed, and 20 experienced clinical worsening within 1 year after the completion of treatment. Although retreatment with the same regimen or a regimen including new quinolones was carried out for these patients, we could not achieve negative sputum conversion and/or clinical improvement. Conclusions: We believe that the dose of clarithromycin for pulmonary MAC disease may be increased and recommend surgery for patients with a localized lesion at early-stage MAC disease to prevent a high rate of relapse. Copyright (C) 2006 S. Karger AG, Basel.