Emergence and Spread of Drug Resistant Neisseria gonorrhoeae
Emergence and Spread of Drug Resistant Neisseria gonorrhoeae
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DOI：
10.1016/j.juro.2010.04.078
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发表时间：
2010-09-01
影响因子：
6.6
通讯作者：
Maeda, Shin-ichi
中科院分区：
文献类型：
--
作者：
Deguchi, Takashi;Nakane, Keita;Maeda, Shin-ichi
目的：对口服抗生素耐药的淋球菌的出现和传播给淋病的治疗带来了困难。我们回顾了淋球菌对氟喹诺酮类药物、头孢克新和阿奇霉素的耐药性。材料和方法：对1943-2009年间发表在MEDLINE(R)/PubMed(R)上的同行评议期刊中的文献以及这些文章中引用的资源进行全面综述。结果：由于耐氟喹诺酮类药物的流行，不再推荐氟喹诺酮类药物治疗淋病。与口服头孢菌素耐药相关的带有嵌合型青霉素结合蛋白2的淋病奈瑟菌的出现威胁到了头孢克辛治疗淋病。出现对阿奇霉素高度耐药的淋病奈瑟菌也已被记录在案。然而，注射用抗生素(环孢菌素和头孢曲松)对淋病奈瑟菌仍有抑制作用。为了监测淋病奈瑟菌的耐药性，几个国家和国际项目已经开始发挥作用。结论：治疗淋病的口服方案有限。目前，据我们所知，头孢曲松是治疗淋病最可靠、最有效的药物。为了防止耐药性的进一步出现和在国际上传播，并允许选择适当的治疗方法，需要一个全面的全球方案，包括监测淋病奈瑟菌的耐药性和收集患者流行病学数据。临床医生应有效地治疗淋病患者，始终意识到淋球菌的局部耐药趋势，并应对治疗后的持续性淋病患者进行培养和药敏试验。
Purpose: The emergence and spread of Neisseria gonorrhoeae with resistance to oral antibiotics have led to difficulty in treating gonorrhea. We review drug resistance in N. gonorrhoeae with a particular emphasis on resistance to fluoroquinolones, cefixime and azithromycin.Materials and Methods: Literature selected from peer reviewed journals listed in MEDLINE (R)/PubMed (R) from 1943 to 2009 and from resources cited in those articles was reviewed comprehensively.Results: Due to the spread of fluoroquinolone resistant N. gonorrhoeae fluoroquinolones are no longer recommended for the treatment of gonorrhea. The emergence of N. gonorrhoeae with a mosaic penicillin-binding protein 2 associated with oral cephalosporin resistance has threatened cefixime treatment for gonorrhea. Emergence of N. gonorrhoeae with high level resistance to azithromycin has also been documented. However, injectable antibiotics (sepctinomycin and ceftriaxone) retain their activity against N. gonorrhoeae. To monitor drug resistance in N. gonorrhoeae several national and international programs have become functional.Conclusions: Oral regimens for the treatment of gonorrhea are limited. At present to our knowledge ceftriaxone is the most reliable and available agent for the treatment of gonorrhea. To prevent the further emergence and international spread of drug resistance, and allow for the selection of appropriate treatments, a comprehensive global program is needed including surveillance for drug resistance in N. gonorrhoeae and collection of patient epidemiological data. Clinicians should effectively treat patients with gonorrhea, always being conscious of local trends of drug resistance in N. gonorrhoeae, and should perform culture and antimicrobial susceptibility testing in those with persistent gonorrhea after treatment.