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早期,有限的Mycobacterium ulcerans感染的抗菌治疗:一个随机对照试验
Willemien A Nienhuis1, Ymkje Stienstra, William A Thompson
1Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Netherlands.
Lancet (London, England)
|February 9, 2010
概括
抗菌治疗有效地治愈了早期的布鲁利病. 一个为期4周的链杆菌素和利芬皮辛治疗方案,其次是清红素,显示了与链杆菌素和利芬皮辛治疗8周的疗效相似,减少了注射量.
科学领域:
- 传染性疾病 传染性疾病
- 热带医学 热带医学
- 皮肤病学 皮肤病学
背景情况:
- 手术除菌是Mycobacterium ulcerans感染 (布鲁利病) 的标准.
- 2004年世卫组织的指导方针建议在外科手术的同时进行抗菌药物治疗 (链杆菌素和利番素).
- 以前的证据包括观察性研究和一项小型试点研究.
研究的目的:
- 为了研究两种抗微生物治疗方案对早期Mycobacterium ulcerans感染的疗效.
- 为了比较一个4周的链胺基治疗方案和一个更长的8周的治疗方案.
主要方法:
- 一个平行的,开放的,随机的试验在加纳进行.
- 用PCR确认的早期,有限的M. ulcerans感染的患者被纳入.
- 两组接受了不同持续时间的链杆菌素和利方皮素,其中一组转换为澄菌素.
主要成果:
- 经过1年后的损伤愈合观察到96%的8周 estreptomycin 组和91%的4周 estreptomycin 加上明素组.
- 没有参与者在1年后出现病变复发.
- 不良事件包括静脉毒性事件和注射,在4周的克拉里斯罗米辛组的发病率略高.
结论:
- 抗菌治疗对于早期的,有限的M. ulcerans感染是有效的.
- 一个为期4周的思列托米辛/里法辛治疗方案,其次是澄胺,与8周的思列托米辛/里法辛治疗方案同样有效.
- 在4周后切换为口服克拉里思罗米辛,可以减少注射链杆菌素的次数.
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