Antibiotic Treatment of Mycobacterium abscessus Lung Disease A Retrospective Analysis of 65 Patients
Antibiotic Treatment of Mycobacterium abscessus Lung Disease A Retrospective Analysis of 65 Patients
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DOI：
10.1164/rccm.200905-0704oc
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发表时间：
2009-11-01
影响因子：
24.7
通讯作者：
Koh, Won-Jung
中科院分区：
文献类型：
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作者：
Jeon, Kyeongman;Kwon, O. Jung;Koh, Won-Jung
理由：脓肿分枝杆菌肺病的最佳治疗方案和治疗时间尚未确定。目的：评价一种标准化联合抗生素治疗脓肿分枝杆菌肺病的疗效。方法：65例脓肿分枝杆菌肺病患者（男111例，女55例，中位年龄55岁）在住院前4周采用克拉霉素、环丙沙星和多西环素联合阿米卡星和头孢西丁的初始方案治疗。测量和主要结果：症状治疗有效率为83%，高分辨率计算机断层扫描治疗有效率为74%。38例（58%）患者实现了痰转化和痰培养阴性维持12个月以上。这些比率在克拉霉素耐药患者（17%,2/12）中显著低于克拉霉素敏感或中间患者（64%,21/33;P = 0.007）。头孢西丁相关的中性粒细胞减少症和血小板减少症分别发生在33例（51%）和4例（6%）患者中。10例（15%）患者发生药物性肝毒性。由于这些不良反应，39例（60%）患者在治疗中位数为22天后停用头孢西丁。结论：标准化联合抗生素治疗脓肿支原体肺病疗效中等。然而，频繁的不良反应和长期住院的可能性是仍有待解决的重要问题。
Rationale: The optimal therapeutic regimen and duration of treatment for Mycobacterium abscessus lung disease is not well established.Objectives: To assess the efficacy of a standardized combination antibiotic therapy for the treatment of M. abscessus lung disease.Methods: Sixty-five patients (111 males, 55 females, median age 55 yr) with M. abscessus lung disease were treated with clarithromycin, ciprofloxacin, and doxycycline, together with an initial regimen of amikacin and cefoxitin for the first 4 weeks of hospitalization.Measurements and Main Results: Treatment response rates were 83% for symptoms and 74% for high-resolution computed tomography. Sputum conversion and maintenance of negative sputum cultures for more than 12 months was achieved in 38 (58%) patients. These rates were significantly lower in patients whose isolates were resistant to clarithromycin (17%, 2/12) compared with those whose isolates were susceptible or intermediate to clarithromycin (64%, 21/33; P = 0.007). Neutropenia and thrombocytopenia associated with cefoxitin developed in 33 (51%) and 4 (6%) patients, respectively. Drug-induced hepatotoxicity occurred in 10 (15%) patients. Because of these adverse reactions, cefoxitin was discontinued in 39 (60%) patients after treatment for a median of 22 days.Conclusions: Standardized combination antibiotic therapy was moderately effective in treating M. abscessus lung disease. However, frequent adverse reactions and the potential for long-duration hospitalization are important problems that remain to be solved.