A randomized controlled comparison of azithromycin and ofloxacin for treatment of multidrug-resistant or nalidixic acid-resistant enteric fever
A randomized controlled comparison of azithromycin and ofloxacin for treatment of multidrug-resistant or nalidixic acid-resistant enteric fever
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DOI：
10.1128/aac.44.7.1855-1859.2000
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发表时间：
2000-07-01
影响因子：
4.9
通讯作者：
Farrar, JJ
中科院分区：
文献类型：
--
作者：
Chinh, NT;Parry, CM;Farrar, JJ
为了检验短期阿奇霉素和氧氟沙星治疗多药耐药（MDR，即对氯霉素、氨苄西林和复方新诺明耐药）和萘啶酸耐药肠热的疗效和安全性，在一项开放随机研究中，比较了阿奇霉素（每天1 g 1次，连续5天，剂量为20mg /kg/天）和氧氟沙星（每天200 mg口服两次，连续5天，剂量为8mg /kg/天）在一家医院住院的无并发症肠热成人患者中的疗效和安全性。共纳入88例血培养确诊患者（86例为伤寒沙门氏菌血清型，2例为甲型副伤寒沙门氏菌S型），其中44例接受阿奇霉素治疗，44例接受氧氟沙星治疗，87株中68株（78%）为耐多药伤寒血清型，87株中46株（53%）耐萘啶酸。阿奇霉素的MIC90（范围）为8 (4 ~ 16)μ g/ml。对萘啶酸敏感的氧氟沙星MIC90范围为0.03 (0.015 ~ 0.06)μ g/ml，对萘啶酸耐药的MIC90范围为0.5 (0.25 ~ 1.0)μ g/ml。没有显著差异在整个临床治愈率与氧氟沙星和阿奇霉素(38 44(86.4%)和42 44 (95.5%);P = 0.27)或在患者感染萘啶耐酸伤寒(21 17(81.0%)和24 25 (96.0%);P = 0.16),然而,萘啶耐酸伤寒患者治疗与氧氟沙星更长的热间隙时间与阿奇霉素治疗(174(60 - 264)与135年(72 - 186)h;P = 0.004)，治疗结束后粪便培养呈阳性（17例中有7例[41%]，19例中有0例[0%]；P = 0.002）。两种抗生素耐受性良好。5天疗程的阿奇霉素对耐多药和耐钠地酸血清型伤寒引起的肠热有效，而选择氧氟沙星方案对这些菌株不太满意。
To examine the efficacy and safety of short courses of azithromycin and ofloxacin for treating multidrug-resistant (MDR, i.e,, resistant to chloramphenicol, ampicillin, and cotrimoxazole) and nalidixic acid-resistant enteric fever, azithromycin (1 g once daily for 5 days at 20 mg/kg/day) and ofloxacin (200 mg orally twice a day for 5 days at 8 mg/kg/day) were compared in an open randomized study in adults admitted to a hospital with uncomplicated enteric fever. A total of 88 blood culture-confirmed patients were enrolled in the study (86 with Salmonella enterica serovar Typhi and 2 with S, enterica serovar Paratyphi A), Of these, 44 received azithromycin and 44 ofloxacin, A total of 68 of 87 (78%) isolates were MDR serovar Typhi, and 46 of 87 (53%) were nalidixic acid resistant. The MIC90 (range) of azithromycin was 8 (4 to 16) mu g/ml for the isolates. The MIC90 (range) of ofloxacin for the nalidixic acid-sensitive isolates,vas 0.03 (0.015 to 0.06) mu g/ml and for the nalidixic acid-resistant isolates it was 0.5 (0.25 to 1.0) mu g/ml. There was no significant difference in the overall clinical cure rate with ofloxacin and azithromycin (38 of 44 [86.4%] versus 42 of 44 [95.5%]; P = 0.27) or in the patients infected with nalidixic acid-resistant typhoid (17 of 21 [81.0%] versus 24 of 25 [96.0%]; P = 0.16), However, patients with nalidixic acid-resistant typhoid treated with ofloxacin had a longer fever clearance time compared with those treated with azithromycin (174 [60 to 264] versus 135 [72 to 186] h; P = 0.004) and had positive fecal cultures after the end of treatment (7 of 17 [41%] versus 0 of 19 [0%]; P = 0.002). Both antibiotics were well tolerated. A 5 day course of azithromycin was effective for the treatment of enteric fever due to MDR and nalidixic-acid-resistant serovar Typhi, whereas the ofloxacin regimen chosen was less satisfactory for these strains.