The impact of long-term azithromycin on antibiotic resistance in HIV-associated chronic lung disease

Background: Selection for resistance to azithromycin (AZM) and other antibiotics such as tetracyclines and lincosamides remains a concern with long-term AZM use for treatment of chronic lung diseases (CLD). We investigated the impact of 48 weeks of AZM on the carriage and antibiotic resistance of common respiratory bacteria among children with HIV-associated CLD.

Methods: Nasopharyngeal (NP) swabs and sputa were collected at baseline, 48 and 72 weeks from participants with HIV-associated CLD randomised to receive weekly AZM or placebo for 48 weeks and followed post-intervention until 72 weeks. The primary outcomes were prevalence and antibiotic resistance of Streptococcus pneumoniae (SP), Staphylococcus aureus (SA), Haemophilus influenzae (HI), and Moraxella catarrhalis (MC) at these timepoints. Mixed-effects logistic regression and Fisher's exact test were used to compare carriage and resistance respectively.

Results: Of 347 (174 AZM, 173 placebo) participants (median age 15 year...

背景：长期使用阿奇霉素（AZM）治疗慢性肺病（CLD）时，细菌对AZM及四环素类、林可酰胺类等其他抗生素的耐药性选择仍是一个值得关注的问题。本研究旨在探讨48周AZM治疗对HIV相关慢性肺病儿童常见呼吸道细菌携带情况及抗生素耐药性的影响。

方法：将HIV相关慢性肺病患者随机分为两组，一组每周接受AZM治疗，另一组接受安慰剂，持续48周；干预结束后随访至72周。分别在基线、48周及72周时采集受试者的鼻咽拭子（NP）和痰标本。主要结局指标为上述时间点肺炎链球菌（SP）、金黄色葡萄球菌（SA）、流感嗜血杆菌（HI）及卡他莫拉菌（MC）的携带率及其抗生素耐药性。分别采用混合效应逻辑回归和Fisher精确检验比较细菌携带情况及耐药性。

结果：共纳入347名受试者（其中AZM组174名，安慰剂组173名），中位年龄为15岁...