Metronidazole Is Still the Drug of Choice for Treatment of Anaerobic Infections
Metronidazole Is Still the Drug of Choice for Treatment of Anaerobic Infections
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DOI：
10.1086/647939
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发表时间：
2010-01-01
影响因子：
11.8
通讯作者：
Nord, Carl Erik
中科院分区：
文献类型：
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作者：
Lofmark, Sonja;Edlund, Charlotta;Nord, Carl Erik
甲硝唑用于治疗感染已有145年的历史，至今仍成功地用于治疗滴虫病、阿米巴病和贾第鞭毛虫病。类杆菌、梭菌和梭状芽孢杆菌引起的厌氧性细菌感染对甲硝唑治疗反应良好。在治疗加德纳氏菌引起的阴道病方面也有很好的临床效果。对甲硝唑的耐药率总体上仍然很低；然而，一些研究报告了类杆菌属物种的敏感性降低，以及不同的耐药机制。已有对甲硝唑耐药的幽门螺杆菌菌株的描述，但仍建议在胃十二指肠溃疡患者中使用联合疗法(如甲硝唑、阿莫西林或克拉霉素加奥美拉唑)来根除这种病原体。甲硝唑具有成本低、抗病原性厌氧菌活性好、药代动力学和药效学特性好、不良反应小等优点，被认为是一种经济有效的药物。正如Tally和他的同事35年前所描述的那样，甲硝唑仍然是厌氧菌感染治疗的标准标准。
Metronidazole has been used for the treatment of infections for 145 years and is still successfully used for the treatment of trichomoniasis, amoebiasis, and giardiasis. Anaerobic bacterial infections caused by Bacteroides species, fusobacteria, and clostridia respond favorably to metronidazole therapy. Good clinical results in the treatment of vaginosis due to Gardnerella vaginalis have also been reported. Rates of resistance to metronidazole are still generally low; however, several studies have reported decreased susceptibility among Bacteroides species, as well as different mechanisms of resistance. Metronidazole-resistant Helicobacter pylori strains have been described, but combination therapy (eg, metronidazole, amoxicillin, or clarithromycin plus omeprazole) is still recommended for eradication of this pathogen in patients with gastroduodenal ulcers. Metronidazole is considered to be a cost-effective drug because of its low cost, good activity against pathogenic anaerobic bacteria, favorable pharmacokinetic and pharmacodynamic properties, and minor adverse effects. Metronidazole is still the criterion standard for therapy of anaerobic infections, as was described by Tally and colleagues 35 years ago.