New York City Department of Health and Mental Hygiene, Office of the Commissioner, 42-09 28th Street, 8-62, Queens, NY 11101, USA.
Sex Transm Infect. 2012 Dec;88(8):589-94. doi: 10.1136/sextrans-2012-050604. Epub 2012 Aug 23.
The development of resistance to multiple antimicrobial agents has limited treatment options for gonorrhoea. The potential emergence of cephalosporin resistance in Neisseria gonorrhoeae and cephalosporin allergy in some patients make it necessary to evaluate the effectiveness of other available antimicrobial agents. Gentamicin is widely available in the USA and is used for gonorrhoea treatment in several countries. We conducted a systematic review of the medical literature to assess the effectiveness of gentamicin for treatment of uncomplicated urogenital gonococcal infections.
Two reviewers assessed relevant articles and independently selected studies that met prespecified selection criteria (including systematic enrolment and assignment to treatment and culture-confirmed diagnosis and outcome). Summary measures for selected studies were pooled using inverse variance-weighted averages with fixed effects. Heterogeneity was assessed using I(2), which estimates proportion (0-100%) of variability attributable to heterogeneity between studies. Pooled percentage with negative follow-up culture was compared with Centers for Disease Control and Prevention (CDC) criteria for selection of recommended therapy (lower 95% CI of efficacy ≥95%).
Twenty-nine potentially relevant studies were identified; three met inclusion criteria. Two studies used 240 mg intramuscular gentamicin and one used 280 mg. Percentages with negative culture after single-dose treatment were 90.7% (n=86), 91.4% (n=220) and 95.0% (n=40). Pooled percentage with negative culture after single-dose treatment was 91.5% (95% CI 88.1% to 94.0%, I(2)=0%).
Gentamicin does not meet current CDC criteria for recommended treatment of gonorrhoea. However, if cephalosporin resistance emerges, gentamicin may be a useful alternative agent. Evaluation of additional regimens, including combination therapy, is warranted.
多种抗菌药物耐药性的发展限制了淋病的治疗选择。淋病奈瑟菌头孢菌素耐药性的潜在出现和某些患者对头孢菌素的过敏反应，使得有必要评估其他可用抗菌药物的有效性。庆大霉素在美国广泛应用，并在多个国家用于淋病治疗。我们对医学文献进行了系统评价，以评估庆大霉素治疗单纯性泌尿生殖系淋病奈瑟菌感染的疗效。
两名审查员评估了相关文章，并独立选择符合预定选择标准的研究（包括系统纳入和分配治疗以及培养证实的诊断和结果）。使用固定效应的逆方差加权平均值汇总选定研究的汇总措施。使用 I²评估异质性，该指标估计研究之间差异归因于异质性的比例（0-100%）。与疾病控制和预防中心（CDC）选择推荐疗法的标准（疗效的 95%置信区间下限≥95%）相比，比较了具有阴性随访培养的汇总百分比。
确定了 29 项潜在相关研究，其中 3 项符合纳入标准。两项研究使用 240mg 肌内庆大霉素，一项研究使用 280mg。单剂量治疗后培养阴性的百分比分别为 90.7%（n=86）、91.4%（n=220）和 95.0%（n=40）。单剂量治疗后培养阴性的汇总百分比为 91.5%（95%CI 88.1%至 94.0%，I²=0%）。
庆大霉素不符合当前 CDC 推荐淋病治疗的标准。但是，如果出现头孢菌素耐药性，庆大霉素可能是一种有用的替代药物。需要评估其他方案，包括联合治疗。
