Azithromycin Treatment Failure for Chlamydia trachomatis Among Heterosexual Men With Nongonococcal Urethritis.
Azithromycin Treatment Failure for Chlamydia trachomatis Among Heterosexual Men With Nongonococcal Urethritis.
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DOI：
10.1097/olq.0000000000000489
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发表时间：
2016-10
影响因子：
3.1
通讯作者：
Martin DH
中科院分区：
文献类型：
--
作者：
Kissinger PJ;White S;Manhart LE;Schwebke J;Taylor SN;Mena L;Khosropour CM;Wilcox L;Schmidt N;Martin DH
最近的三项前瞻性研究表明，1 g剂量的阿奇霉素治疗沙眼衣原体（Ct）的效果不如预期，报告了广泛的治疗失败率（5.8%-22.6%）。不同结果的原因可归因于地理或方法上的差异。本研究的目的是重新检查这些研究，并试图协调方法，以减少由于早期治愈试验（TOC）的假阳性而导致的错误分类或由于性暴露而不是治疗失败而导致的再感染。研究对象包括与女性发生性行为的男性，在直接观察治疗（DOT）下接受1g阿奇霉素治疗非淋球菌性尿道炎（NGU），并确诊为Ct。尿道口拭子或尿液进行基线筛查，尿液采用核酸扩增试验（NAAT）进行TOC筛查。治疗后阴道性暴露在TOC引起。从三个研究中获得数据并重新分析。对所有病例的Ct再检测阳性率进行检查，并进行敏感性分析，将潜在的假阳性/再感染重新分类为阴性或从分析中删除。粗处理失败率为12.8%（31/242）。潜在的假阳性/再感染被重新分类为阴性的比率为6.2%(15/242)，或将其排除在分析之外的比率为10.9%（15/138）。在这些与ct相关的NGU发生性关系的男性样本中，阿奇霉素治疗失败的比例在6.2%至12.8%之间。这一失败率范围低于先前公布的，但高于世界卫生组织所期望的衣原体治疗失败率< 5%的目标。
Three recent prospective studies have suggested that the 1 g dose of azithromycin for Chlamydia trachomatis (Ct) was less effective than expected, reporting a wide range of treatment failure rates (5.8%–22.6%). Reasons for the disparate results could be attributed to geographic or methodological differences. The purpose of this study was to re-examine the studies and attempt to harmonize methodologies to reduce misclassification as a result of false positives from early test-of-cure (TOC) or reinfection as a result of sexual exposure rather than treatment failure. Men who had sex with women, who received 1 g azithromycin under directly observed therapy (DOT) for presumptive treatment of nongonococcal urethritis (NGU) with confirmed Ct were included. Baseline screening was performed on urethral swabs or urine and TOC screening was performed on urine using nucleic acid amplification tests (NAAT). Post-treatment vaginal sexual exposure was elicited at TOC. Data from the three studies was obtained and re-analyzed. Rates of Ct re-test positive were examined for all cases and a sensitivity analysis was conducted to either reclassify potential false positives/reinfections as negative or remove them from the analysis. The crude treatment failure rate was 12.8% (31/242). The rate when potential false positives/reinfections were reclassified as negative was 6.2% (15/242) or when these were excluded from analysis was 10.9% (15/138). In these samples of men who have sex with women with Ct-related NGU, azithromycin treatment failure was between 6.2% and 12.8%. This range of failure is lower than previously published but higher than the desired World Health Organization’s target chlamydia treatment failure rate of < 5%.