EFFECT OF SPECTINOMYCIN USE ON THE PREVALENCE OF SPECTINOMYCIN-RESISTANT AND OF PENICILLINASE-PRODUCING NEISSERIA-GONORRHOEAE
EFFECT OF SPECTINOMYCIN USE ON THE PREVALENCE OF SPECTINOMYCIN-RESISTANT AND OF PENICILLINASE-PRODUCING NEISSERIA-GONORRHOEAE
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DOI：
10.1056/nejm198707303170504
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发表时间：
1987-07-30
影响因子：
158.5
通讯作者：
STEIN, DC
中科院分区：
文献类型：
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作者：
BOSLEGO, JW;TRAMONT, EC;STEIN, DC
由于产青霉素酶淋病奈瑟菌在韩国的高流行率，自1981年以来，壮观霉素已被用于美国军事人员淋球菌感染的初级治疗，但越来越多的报告显示壮观霉素治疗失败。我们进行了一项临床研究，以确定大观霉素治疗124名美国军人在韩国谁有尿道淋球菌感染的疗效。97例患者单独使用大观霉素治疗，并在随访中进行评价。在8名患者（8.2%）中，这种治疗不成功。对来自7名治疗失败的患者的分离物进行的抗生素敏感性测试表明，6个分离物对壮观霉素具有高度抗性（最小抑制浓度，≥ 100 mg/ml）。100 μ g/ml）。没有一个壮观霉素耐药菌株通过产生青霉素酶或染色体突变而对青霉素产生耐药性。虽然壮观霉素耐药的机制似乎是一个染色体突变，这些菌株通常对其他抗生素敏感。壮观霉素耐药性的普遍存在导致在韩国的美国军事人员获得淋病的主要治疗中头孢曲松的替代品。我们认为，壮观霉素耐药性在这一人群中的迅速出现，要求对药物的大规模使用采取谨慎的态度，并表明需要扩大目前的监测计划。
Because of the high prevalence of penicillinase-producing Neisseria gonorrhoeae in the Republic of Korea, spectinomycin has been used there in the primary treatment of gonococcal infections in U.S. military personnel since 1981, but there have been increasingly frequent reports of treatment failures with spectinomycin. We conducted a clinical study to determine the efficacy of spectinomycin treatment in 124 U.S. servicemen in the Republic of Korea who had urethral gonococcal infections. Ninety-seven patients were treated with spectinomycin alone and evaluated in a follow-up visit. In eight patients (8.2 percent), this treatment was unsuccessful. Antibiotic-sensitivity testing on isolates from seven of the patients with treatment failure demonstrated that six isolates were highly resistant to spectinomycin (minimal inhibitory concentration, .gtoreq. 100 .mu.g per milliliter). None of the spectinomycin-resistant strains had become resistant to penicillin, either through the production of penicillinase or through a chromosomal mutation. Although the mechanism of spectinomycin resistance appears to be a chromosomal mutation, these isolates were generally sensitive to other antibiotics. The prevalence of resistance to spectinomycin resulted in the substitution of ceftriaxone for the primary treatment of gonorrhea acquired by U.S. military personnel in the Republic of Korea. We believe that the rapid emergence of spectinomycin resistance in this population mandates a cautious approach to widescale use of the drug and indicates a need to broaden current surveillance programs.