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CID:三联疗法可有效预防接触MDR-TB的儿童感染肺结核

2013-09-29 陈郁婷 dxy

目前鲜有相关资料可用于指导接触耐多药(MDR)结核(TB)儿童的管理。因此,来自南非斯坦陵布什大学的James A Seddon等人展开一项前瞻性队列研究,旨在探讨一种预防性标准疗法的耐受性和毒性,并试图发现引起不良转归的危险因素,该疗法适用于接触了感染性MDR-TB的儿童。他们的研究结果于2013年9月24日在线发表于《临床感染性疾病》(Clinical Infectious Diseases)

目前鲜有相关资料可用于指导接触耐多药(MDR)结核(TB)儿童的管理。因此,来自南非斯坦陵布什大学的James A Seddon等人展开一项前瞻性队列研究,旨在探讨一种预防性标准疗法的耐受性和毒性,并试图发现引起不良转归的危险因素,该疗法适用于接触了感染性MDR-TB的儿童。他们的研究结果于2013年9月24日在线发表于《临床感染性疾病》(Clinical Infectious Diseases)杂志上。作者发现,这一三药联合的预防性疗法具有良好的耐受性,在坚持用药的情况下,接触MDR-TB的儿童极少出现TB感染或死亡。【原文下载

这是一项前瞻性队列研究,在南非西开普开展。在2010年5月至2011年4月期间,研究人员招募接触了氧氟沙星敏感型MDR-TB源病例且年龄小于5岁的儿童或年龄小于15岁的HIV(人类免疫缺陷病毒)阳性儿童。这些儿童按照当地相关的指导资料开始接受为期六个月的预防性治疗,该预防性疗法含有:氧氟沙星、乙胺丁醇和高剂量的异烟肼。根据标准化量表记录参试者用药的依从性和不良事件,将不良转归定义为感染TB或由任意原因引起的死亡。

研究结果如下:该研究一共纳入了186名儿童,年龄中位数为34个月,四分位数间距为14-47个月。在进行了HIV检测的179名儿童中,9名为HIV阳性。其中的141名儿童依从性较好。只有7名儿童发生3级不良事件。在为期219患者年的观察期内,1名儿童死亡,6名儿童感染TB。与不良转归相关的因素包括:年龄小于1岁,HIV阳性,接触多名源病例,以及依从性差。
研究发现,这一三药联合的预防性疗法具有良好的耐受性,在坚持用药的情况下,极少出现TB感染或死亡。应当考虑为接触MDR-TB的易感儿童提供预防性治疗。


原文下载

Seddon JA, Hesseling AC, Finlayson H, Fielding K, Cox H, Hughes J, Godfrey-Faussett P, Schaaf HS.Preventive therapy for child contacts of multidrug-resistant tuberculosis: a prospective cohort study.Clin Infect Dis. 2013 Sep 24.


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    2013-12-11 clmlylxy
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    2014-09-05 xlxchina
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    2014-02-03 syscxl
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