Bryan J P, Hira S K, Brady W, Luo N, Mwale C, Mpoko G, Krieg R, Siwiwaliondo E, Reichart C, Waters C
Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814.
Antimicrob Agents Chemother. 1990 May;34(5):819-22. doi: 10.1128/AAC.34.5.819.
Neisseria gonorrhoeae strains resistant to treatment with penicillin, tetracycline, and/or spectinomycin are increasing in prevalence in many parts of the world. In Zambia, 52% of N. gonorrhoeae isolates produced beta-lactamase in 1986. Few oral regimens have proven effective for treatment of resistant N. gonorrhoeae. We conducted a prospective, double-blind, randomized clinical trial of 250 mg of ciprofloxacin given orally versus 250 mg of ceftriaxone given intramuscularly for treatment of uncomplicated gonococcal urethritis in adult males. Two hundred men were enrolled and treated. The two groups were comparable in age (27.5 years), prevalence of latent syphilis (14 and 10%), and human immunodeficiency virus infection (32 and 38%). Of 165 patients with cultures positive for N. gonorrhoeae who returned for follow-up, ciprofloxacin cured 83 of 83 (100%), including 26 with penicillinase-producing N. gonorrhoeae (PPNG) and 21 with N. gonorrhoeae with chromosomally mediated resistance to multiple antibiotics (CMRNG), and ceftriaxone cured 81 of 82 (98.7%), including 30 with PPNG and 19 with CMRNG. Both treatment regimens were well tolerated. Chlamydia trachomatis in urethral exudate was found by direct fluorescent-antibody microscopic examination or by culture in 10 (5%) participants. All N. gonorrhoeae isolates were inhibited by ceftriaxone at 0.06 micrograms/ml, except one which was inhibited at 0.125 micrograms/ml, while ciprofloxacin inhibited all isolates at 0.03 micrograms/ml. Ciprofloxacin is a safe and effective therapy for uncomplicated gonococcal urethritis, including that caused by PPNG and CMRNG in human immunodeficiency virus-infected men.
对青霉素、四环素和/或壮观霉素治疗耐药的淋病奈瑟菌菌株在世界许多地区的流行率正在上升。在赞比亚，1986年52%的淋病奈瑟菌分离株产生β-内酰胺酶。很少有口服方案被证明对耐药淋病奈瑟菌有效。我们进行了一项前瞻性、双盲、随机临床试验，比较口服250毫克环丙沙星与肌肉注射250毫克头孢曲松治疗成年男性单纯性淋菌性尿道炎的效果。200名男性入组并接受治疗。两组在年龄（27.5岁）、潜伏梅毒患病率（14%和10%）以及人类免疫缺陷病毒感染率（32%和38%）方面具有可比性。在165名淋病奈瑟菌培养阳性并返回接受随访的患者中，环丙沙星治愈了83例中的83例（100%），包括26例产青霉素酶淋病奈瑟菌（PPNG）和21例对多种抗生素具有染色体介导耐药性的淋病奈瑟菌（CMRNG），头孢曲松治愈了82例中的81例（98.7%），包括30例PPNG和19例CMRNG。两种治疗方案耐受性均良好。通过直接荧光抗体显微镜检查或培养在10名（5%）参与者的尿道分泌物中发现沙眼衣原体。除1株在0.125微克/毫升被抑制外，所有淋病奈瑟菌分离株在0.06微克/毫升时均被头孢曲松抑制，而环丙沙星在0.03微克/毫升时抑制所有分离株。环丙沙星是治疗单纯性淋菌性尿道炎的一种安全有效的疗法，包括由人类免疫缺陷病毒感染男性中的PPNG和CMRNG引起的尿道炎。
