给编辑:
我们很感兴趣地阅读Southern和Barker的文章1. The authors critically reviewed the evidence from the randomised, controlled trials of the role of azithromycin in the management of cystic fibrosis (CF). In the three randomised, controlled studies described, the effects of up to 6 months of therapy with azithromycin in CF have been reported2–4. However, the controlled setting of randomised trials may differ from the clinical practice. Therefore, we can understand the authors' cautious closing remark on the precise role of azithromycin in the clinical setting.
We have recently audited our use of long-term azithromycin therapy in adult patients attending the Regional Adult CF unit, Leeds, UK5. A total of 36 patients (17 female), all of whom were colonised withPseudomonas aeruginosa, had 500 mg of azithromycin 3 times·week−1for a mean±sdperiod of 9±6 months. Mean age, Northern chest radiograph score, Shwachman-Kulczycki score and forced expiratory volume in one second (FEV1) were 24±7 yrs, 12±3, 68±14, and 1.9±0.9 L, respectively. In the group as a whole, there was no overall change in lung function during the treatment period. However, we were able to identify a subgroup of 24 patients in whom therapy with azithromycin was associated with a mean±sdFEV增加1by 0.3±0.2 L. This group had significantly lower levels of antibodies toP. aeruginosa(p = 0.007),中位(范围)为19(4-136)versus40 (5–325) U·mL−1, and a lower number of exacerbations requiringi.v.在开始阿奇霉素之前的12个月中的抗生素(3(1-6)versus5(2-7);与那些肺功能保持不变的患者相比,p = 0.01)。
We believe that our findings provide additional information on the clinical use of azithromycin. First, not all patients colonised withP. aeruginosaimprove with azithromycin therapy. Secondly, the CF patients in whom treatment with azithromycin is more likely to be associated with improvements in lung function are characterised by a lower immunological response toP. aeruginosa以及较低的加重频率。
Our data suggest that therapy with azithromycin should be considered earlier in the disease process. Further data on whether therapy should be introduced before colonisation withPseudomonas aeruginosaoccurs is required.
- 已收到2004年11月11日。
- Accepted2004年11月16日。
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