Ferraro M J
Dept of Clinical Microbiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
J Chemother. 2002 Jul;14 Suppl 3:31-41. doi: 10.1080/1120009x.2002.11782350.
Fluoroquinolone antibiotics have been available since the 1980s when ciprofloxacin and norfloxacin were licensed. Structural revisions of the quinolone molecule have provided new compounds that were well suited to the treatment of upper and lower community-acquired respiratory tract infections, having good activity against Streptococcus pneumoniae. Nevertheless, it was only a matter of time before the pneumococcus developed effective resistance against these new agents. There are populations of fluoroquinolone-resistant S. pneumoniae and, more worryingly, many of these strains are also resistant to penicillin and to macrolides. Surveillance studies such as PROTEKT (Prospective, Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin) can provide an early warning system and, with the provision of global surveillance on a local level, can assist in the selection of empirical antibiotic treatment. The new ketolide antibiotic, telithromycin, has excellent activity against the major community-acquired respiratory pathogens (including atypical/intracellular organisms), and has the advantage of retaining its activity against strains of S. pneumoniae that are resistant to penicillin, macrolides and fluoroquinolones.
自20世纪80年代环丙沙星和诺氟沙星获批以来，氟喹诺酮类抗生素就已问世。喹诺酮分子的结构改良产生了新的化合物，这些化合物非常适合治疗社区获得性上下呼吸道感染，对肺炎链球菌具有良好活性。然而，肺炎球菌对这些新药物产生有效耐药只是时间问题。现在存在耐氟喹诺酮的肺炎链球菌群体，更令人担忧的是，其中许多菌株还对青霉素和大环内酯类耐药。诸如PROTEKT（酮内酯类泰利霉素的前瞻性耐药菌追踪与流行病学研究）等监测研究可以提供早期预警系统，并且通过在地方层面提供全球监测，有助于选择经验性抗生素治疗。新型酮内酯类抗生素泰利霉素对主要的社区获得性呼吸道病原体（包括非典型/细胞内病原体）具有优异活性，并且具有对耐青霉素、大环内酯类和氟喹诺酮类的肺炎链球菌菌株仍保持活性的优势。
