摘要

BACKGROUND: Treatment regimens for active tuberculosis (TB) that are intermittent, or use rifampin during only the initial phase, offer practical advantages, but their efficacy has been questioned. We conducted a systematic review of treatment regimens for active TB, to assess the effect of duration and intermittency of rifampin use on TB treatment outcomes. METHODS AND FINDINGS: PubMed, Embase, and the Cochrane CENTRAL database for clinical trials were searched for randomized controlled trials, published in English, French, or Spanish, between 1965 and June 2008. Selected studies utilized standardized treatment with rifampin-containing regimens. Studies reported bacteriologically confirmed failure and/or relapse in previously untreated patients with bacteriologically confirmed pulmonary TB. Pooled cumulative incidences of treatment outcomes and association with risk factors were computed with stratified random effects meta-analyses. Meta-regression was performed using a negative binomial regression model. A total of 57 trials with 312 arms and 21,472 participants were included in the analysis. Regimens utilizing rifampin only for the first 1-2 mo had significantly higher rates of failure, relapse, and acquired drug resistance, as compared to regimens that used rifampin for 6 mo. This was particularly evident when there was initial drug resistance to isoniazid, streptomycin, or both. On the other hand, there was little evidence of difference in failure or relapse with daily or intermittent schedules of treatment administration, although there was insufficient published evidence of the efficacy of twice-weekly rifampin administration throughout therapy. CONCLUSIONS: TB treatment outcomes were significantly worse with shorter duration of rifampin, or with initial drug resistance to isoniazid and/or streptomycin. Treatment outcomes were similar with all intermittent schedules evaluated, but there is insufficient evidence to support administration of treatment twice weekly throughout therapy.

译文

背景: 间歇性的活动性结核病 (TB) 治疗方案,或仅在初始阶段使用利福平,提供了实际优势,但其疗效受到质疑。我们对活动性结核病的治疗方案进行了系统回顾,以评估利福平使用的持续时间和间歇性对结核病治疗结果的影响。方法和结果: 检索 PubMed 、 Embase 和 Cochrane 中央临床试验数据库,检索 1965年至 2008年6月间以英文、法文或西班牙文发表的随机对照试验。选定的研究采用含利福平方案的标准化治疗。研究报告了先前未经治疗的细菌确诊肺结核患者的细菌确诊失败和/或复发。通过分层随机效应荟萃分析计算治疗结果的累积发生率和与危险因素的关联。使用负二项回归模型进行元回归。分析中总共包括了 57 个试验,其中包括 312 个武器和 21,472 名参与者。与使用利福平治疗 6 个月的治疗方案相比,仅在第一个 1-2 个月使用利福平的治疗方案的失败率、复发率和获得性耐药性明显更高。当最初对异烟肼、链霉素或两者都有耐药性时,这一点尤其明显。另一方面,几乎没有证据表明每日或间歇性给药治疗计划的失败或复发有所不同, 尽管在整个治疗过程中没有足够的公开证据证明每周两次服用利福平的疗效。结论: 随着利福平持续时间的缩短,或对异烟肼和/或链霉素的初始耐药性,结核病治疗结果明显更差。治疗结果与评估的所有间歇计划相似,但没有足够的证据支持在整个治疗过程中每周两次治疗。

Rifampin

呼吸 抗生素类药物 药物
概述  :  

利福平是利福霉素的人工半合成品,橘红色结晶粉末。利福平抗菌谱广且作用强大,对静止期和繁殖期的细菌均有作用,能增加链霉素和异烟肼的抗菌活性。利福平不仅对结核杆菌及麻风杆菌有作用,亦可杀灭多种G+和G-球菌如金黄色葡萄球菌、脑膜炎奈瑟菌等,对G-杆菌如大肠埃希菌、变形杆菌、流感杆菌等也有抑制作用。利福平抗菌强度与其浓度有关,低浓度抑菌、高浓度杀菌,其疗效与异烟肼相当。 抗菌机制利福平可特异性地与细菌依赖于DNA的RNA多聚酶β亚单位结合,阻碍mRNA 的合成,对人和动物细胞内的 RNA

Rifampin   英 /raɪ'fæmpɪn   / 美 /'rɪ'fæmpɪn/ 

释    义   n. (美)利福平(抗生素类药,等于rifampicin)

例    句   A possible exception is rifampin, the antibiotic prescribed for tuberculosis. 一种可能的例外是利福平,一种治疗肺结核的抗生素。

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