[Efficacy and safety of azithromycin prophylaxis of respiratory tract infections in military community].
[Efficacy and safety of azithromycin prophylaxis of respiratory tract infections in military community].
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阿奇霉素预防军队呼吸道感染的有效性和安全性[J].
DOI：
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发表时间：
2004
期刊：
影响因子：
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通讯作者：
S. Rosman
中科院分区：
文献类型：
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作者：
I. A. Guchev;O. I. Klochkov;G. V. Ivanitsa;Iu A Pervov;S. M. Shturmina;S. Rosman
在位于俄罗斯中欧地区的俄罗斯联邦国防部军事训练中心，研究了阿奇霉素预防年轻人社区获得性肺炎（CAP）的有效性和安全性。评估了阿奇霉素与对照的两种预防方案：阿奇霉素，500 mg/w，持续 8 周（R1），阿奇霉素，入组后一次 1500 mg（R2）和不用药（R3）。对鼻咽部肺炎链球菌携带情况及其对抗菌药物的敏感性进行了三次评估：暴露前、暴露后第9周内和暴露后第20周内。当分离株对红霉素和克林霉素耐药时，怀疑存在 MLS(B) 表型。在22周的观察期内，R3组678名受试者中有20.2%被诊断为CAP，R1组508名受试者中有8.6%（风险比=0.4，95% Cl = 0.3-0.6），R2组507名受试者中有10.3%（风险比=0.5，95% Cl = 0.4-0.7）。 0次就诊时肺炎链球菌携带率为34-35%，第9周内R1、R2和R3组分别为75、66和50%（p<0.05），第20周内同一组分别为69、57和36%（p<0.05）。在第 0 次访视时，在测试的 40 个分离株中均未检测到大环内酯类耐药性。 0-14% 的分离株显示出中等青霉素耐药性的背景水平。第9周内，R1组（95.7%，44株耐药菌株，其中37%对Azithro+Clinda耐药）和R2组（89.5%，34株耐药菌株，其中11.9%对Azithro+Clinda耐药）观察到大环内酯类耐药性急剧增加。到第20周，R1组耐药率下降至40%（16株耐药菌株，其中10%对Azithro+Clinda耐药），R2组耐药率下降至22.6%（7株耐药菌株，其中5.4%对Azithro+Clinda耐药）。至于青霉素耐药性，没有检测到不利的变化。该研究证明了阿奇霉素预防 CAP 对暂时性高风险疾病的健康年轻男性的有效性，以及选择耐药地方性病原体的可能风险。
The efficacy and safety of azithromycin prophylaxis of community-acquired pneumonia (CAP) in young adults in a military training centre of the Ministry of Defence of the Russian Federation located in the Central European Region of Russia were studied. Two prophylactic regimens with azithromycin vs. the control were evaluated: azithromycin, 500 mg/w for 8 weeks (R1), azithromycin, 1500 mg once upon the enrolment (R2) and no drugs (R3). Nasopharyngeal carriage of Streptococcuspneumoniae and its susceptibility to antibacterials were estimated thrice: before the exposure, after the exposure within the 9th week and after the exposure within the 20th week. The MLS(B) phenotype was suspected when the isolates were resistant to erythromycin and clindamycin. During the observation period of 22 weeks CAP was diagnosed in 20.2% of 678 subjects in group R3, 8.6% of 508 subjects in group R1 (Risk Ratio =0.4, 95% Cl = 0.3-0.6) and 10.3% of 507 subjects in group R2 (Risk Ratio = 0.5, 95% Cl = 0.4-0.7). The S.pneumoniae carriage rate at visit 0 was 34-35%, within the 9th week it was 75, 66 and 50% (p<0.05) in groups R1, R2 and R3 respectively, and within the 20th week it was 69, 57 and 36% in the same groups (p<0.05). At visit 0 no macrolide resistance was detected in any of the 40 isolates tested. The background level of intermediate penicillin resistance was revealed in 0-14% of the isolates. Dramatic growth of macrolide resistance was observed within the 9th week in group R1 (95.7%, 44 resistant strains, Azithro+Clinda resistance in 37% of them) and in group R2 (89.5%, 34 resistant strains, Azithro+Clinda resistance in 11.9% of them). By the 20th week the resistance rate decreased up to 40 % (16 resistant strains, Azithro+Clinda resistance in 10% of them) in group R1 and up to 22.6% (7 resistant strains, Azithro+Clinda resistance in 5.4% of them) in group R2. As for penicillin resistance, no unfavourable shifts were detected. The study demonstrated the effectiveness of the azithromycin prophylaxis of CAP in healthy young men at high transient risk of the disease, as well as the possible risk for selection of resistant endemic pathogens.