左氧氟沙星在先天性结核病中的应用：两例病例报告及文献综述

文献信息

中文摘要

背景： 先天性结核病（CTB）是一种在宫内或分娩过程中获得的严重且常致命的感染，其治疗仍面临重大挑战。
方法： 我们描述了来自安徽省儿童医院住院部的2例接受左氧氟沙星治疗的CTB病例。此外，我们进行了文献综述，从17篇已发表的含左氧氟沙星抗结核方案治疗CTB的病例报告中识别出18例符合条件的病例，这些报告发表于中文和英文期刊。这些病例与我们的患者一起进行了分析。
结果： 共分析了20例CTB病例。其中，至少80%（16/20）为早产儿。将左氧氟沙星纳入抗结核方案的理由分为4个主要类别：肝功能障碍35%（7/20）、对一线药物耐药45%（9/20）、严重或播散性疾病，如粟粒性结核或结核性脑膜炎20%（4/20），以及意图避免乙胺丁醇的眼毒性10%（2/20）。这些指征并非互斥，因为一些患者有超过1个接受左氧氟沙星的原因。排除1例结局无法评估的病例后，其余19例中有18例（94.74%）治疗有效。应答者中值得注意的结局包括1例儿童有轻度发育迟缓和听力损失。1例患者（5.26%）死亡。在18例患者中均未报告明确的左氧氟沙星相关关节软骨损伤或其他严重不良反应。同样，在我们的2例院内病例随访期间也未检测到关节软骨异常。
结论： 我们建议在特定临床情况下，在严格治疗药物监测下考虑将左氧氟沙星纳入CTB的联合方案。这些情况包括严重的抗结核药物性肝损伤、对一线药物耐药、危重疾病如粟粒性或脑膜疾病，以及必须避免乙胺丁醇眼毒性风险时。

英文摘要

BACKGROUND: Congenital tuberculosis (CTB), a serious and often fatal infection acquired in utero or during delivery, continues to pose significant challenges in treatment.
METHODS: We describe 2 cases of CTB treated with levofloxacin from the inpatient department of Anhui Provincial Children's Hospital. In addition, we performed a literature review and identified 18 eligible cases from 17 published case reports of CTB treated with levofloxacin-containing antituberculosis regimens, which were reported in both Chinese and English journals. These cases were analyzed together with our patients.
RESULTS: A total of 20 cases of CTB were analyzed. Of these, at least 80% (16/20) were preterm infants. The rationale for including levofloxacin in the antituberculosis regimen fell into 4 main categories: hepatic dysfunction 35% (7/20), drug resistance to first-line agents 45% (9/20), severe or disseminated disease, such as miliary tuberculosis or tuberculous meningitis 20% (4/20), and intention to avoid the ocular toxicity of ethambutol 10% (2/20). The indications were not mutually exclusive, as some patients had more than 1 reason for receiving levofloxacin. Excluding one case with unevaluable outcomes, treatment was effective in 18 of the remaining 19 cases (94.74%). Notable outcomes among responders included 1 child with mild developmental delay and hearing loss. One patient (5.26%) died. No definitive levofloxacin-associated articular cartilage damage or other severe adverse reactions were reported in any of the 18 patients. Likewise, no articular cartilage abnormalities were detected during follow-up in our 2 in-house cases.
CONCLUSIONS: We suggest that levofloxacin be considered for inclusion in combination regimens for CTB under strict therapeutic drug monitoring in specific clinical scenarios. These include severe antituberculosis drug-induced liver injury, resistance to first-line agents, critical illness such as miliary or meningeal disease, and when the ocular toxicity risk of ethambutol must be avoided.