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id="6kaem2a" class="zhezhao2"></div> <div class="eu2gmcs" id="content"><div id="seycycs" class="title">新聞中心</div> <div > <h2>氯法齊明治療非結核分枝桿菌?。ǘ?/h2> <div id="i0ias0e" class="pt10"> <p>氯法齊明治療非結核分枝桿菌?。ǘ?br /> 為進(jìn)一步規范我國非結核分枝桿菌（non-tuberculous Mycobacteria，NTM）病的診斷和治療，提高我國廣大醫務(wù)工作者對NTM病的認識和診治水平，中華醫學(xué)會(huì )結核病學(xué)分會(huì )組織相關(guān)領(lǐng)域專(zhuān)家，結合我國的實(shí)際情況，制定了“非結核分枝桿菌病診斷與治療指南（2020年版）”。指南中列出治療NTM病的藥物目前共計17種，其中之一就是氯法齊明。<br /> 指南中還推薦了幾種常見(jiàn)NTM病治療方案，摘錄如下：<br /> 1、堪薩斯分枝桿菌病<br /> （1）利福平敏感：利福平450~600 mg/d（體重<50 kg時(shí)用450 mg/d）、乙胺丁醇750~1000 mg/kg /d和異煙肼300 mg/d或克拉霉素500~1000 mg/d（體重<50 kg時(shí)用500 mg/d）或阿奇霉素250~500 mg/d，口服；療程至少1年。<br />   （2）利福平耐藥：克拉霉素500~1000 mg/d（體重<50 kg時(shí)用500mg/d）或阿奇霉素250~500mg/d、莫西沙星400mg/d、氯法齊明100~200mg/d 或利奈唑胺600mg/d以及乙胺丁醇15mg/kg /d，口服；療程持續至痰培養陰轉后至少1年。<br />   2、瘰疬分枝桿菌<br /> 含氯法齊明100~200 mg/d、克拉霉素 500~1000 mg/d（體重<50 kg時(shí)用 500 mg/d）或阿奇霉素250~500 mg/d、環(huán)丙沙星1000 mg/d和乙胺丁醇15 mg/kg /d，口服；療程持續至痰培養陰轉后至少1年。<br />   3、膿腫分枝桿菌復合群<br /> MABC肺病的治療方案：<br /> （1）克拉霉素敏感或誘導型大環(huán)內酯類(lèi)耐藥患者：<br /> ①初始階段：阿米卡星15mg/kg /d，1次/d，靜脈滴注；替加環(huán)素50 mg/次，2次/d，靜脈滴注；亞胺培南/西司他丁1 g/次，2次/d，靜脈滴注；克拉霉素500 mg/次，2次/d或口服阿奇霉素250~500 mg/d，口服（注：若以上注射類(lèi)藥物不能使用時(shí)，可選用頭孢西丁200 mg/kg /d，分3次給藥，靜脈滴注，最大量不超過(guò)12 g/d）。該階段至少1個(gè)月以上，建議可延長(cháng)至 3~6個(gè)月。<br /> ②延續階段：阿米卡星霧化吸入制劑400mg/次，2次/d，霧化；克拉霉素500 mg/次，2次/d或口服阿奇霉素250~500 mg/d，口服；利奈唑胺600 mg/d，口服；米諾環(huán)素100 mg/次，2次/d，口服；環(huán)丙沙星1000 mg/d 或莫西沙星400 mg/d，口服；利福布汀300 mg/d或氯法齊明100~200 mg/d或復方新諾明960 mg/次，2次/d，口服。療程持續至痰培養陰轉后至少1年。 <br /> （2）大環(huán)內酯類(lèi)高度耐藥患者：<br /> ①初始階段：阿米卡星15 mg/kg /d，1次/d，靜脈滴注；替加環(huán)素50 mg/次，2次/d，靜脈滴注；亞胺培南/西司他丁1 g/次，2次/d，靜脈滴注；頭孢西丁200 mg/kg/d，分3次給藥，靜脈滴注，最大量不超過(guò)12 g/d。該階段至少1個(gè)月以上，建議可延長(cháng)至3~6個(gè)月。<br /> ②延續階段：阿米卡星霧化吸入制劑400 mg/次，2次/d，霧化；利奈唑胺600 mg/d，口服；米諾環(huán)100 mg/次，2次/d，口服；環(huán)丙沙星1000 mg/d或莫西沙星400 mg/d，口服；利福布汀300 mg/d或氯法齊明100~200mg/d或復方新諾明960 mg/次，2次/d，口服。療程持續至痰培養陰轉后至少1年。<br /> 4、龜分枝桿菌<br /> （1）龜分枝桿菌肺病的治療方案：<br /> ①初始階段：阿米卡星15 mg/kg /d，1次/d，靜脈滴注；替加環(huán)素50 mg/次，2次/d，靜脈滴注；亞胺培南/西司他丁1 g/次，2次/d，靜脈滴注；克拉霉素500 mg/次，2次/d或口服阿奇霉素250~500 mg/d，口服。該階段至少1個(gè)月以上，建議可延長(cháng)至3~6個(gè)月。<br /> ②延續階段：阿米卡星霧化吸入制劑400 mg/次，2次/d，霧化；克拉霉素500 mg/次，2次/d 或口服阿奇霉素250~500 mg/d，口服；利奈唑胺600 mg/d，口服；環(huán)丙沙星1000 mg/d 或莫西沙星400 mg/d，口服；氯法齊明100~200 mg/d，口服。療程持續至痰培養陰轉后至少1年。對于局限于單側肺部病灶以及可以耐受手術(shù)者，經(jīng)過(guò)內科治療效果不佳可行外科手術(shù)治療，術(shù)后繼續抗NTM治療直至痰分枝桿菌培養陰轉至少1年后可以停藥。<br /> （3）龜分枝桿菌皮膚、軟組織和骨病的治療方案：<br /> 阿米卡星15 mg/kg/d，1次/d，靜脈滴注，或阿米卡星霧化吸入制劑400 mg/次，2次/d，霧化；亞胺培南/西司他丁1 g/次，2次/d，靜脈滴注；替加環(huán)素50 mg/次，2次/d，靜脈滴注；克拉霉素1000 mg/d或阿奇霉素250 mg/d，口服。若克拉霉素或阿奇霉素耐藥可選用環(huán)丙沙星 1000 mg/d 或莫西沙星 400 mg/d 或氯法齊明 100~200 mg/d，口服。療程至少4個(gè)月，骨病患者的療程至少6個(gè)月。對于病灶廣泛、膿腫形成及藥物療效不佳者，可積極采用外科清創(chuàng )術(shù)或異物清除處理。</p> <p>參考文獻：《非結核分枝桿菌病診斷與治療指南（2020年版）》中華結核和呼吸雜志2020年11月第43卷第11期</p> <p><br /> 溫馨提示：NTM 廣泛存在于水、土壤、灰塵等自然環(huán)境中，人和某些動(dòng)物均可感染。應密切關(guān)注城市飲用水中NTM污染問(wèn)題，嚴格對飲用水進(jìn)行消毒處理，預防NTM從環(huán)境傳播到人</p> <br /> <br /> <p align="center"><a 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