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感染:当前的治疗选择与耐药问题

infections: current treatment options and resistance issues.

作者信息

Sethi Sunil, Zaman Kamran, Jain Neha

机构信息

Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

出版信息

Infect Drug Resist. 2017 Sep 1;10:283-292. doi: 10.2147/IDR.S105469. eCollection 2017.

Abstract

is one of the important causes of non-gonococcal urethritis. Rising incidence and emerging antimicrobial resistance are a major concern these days. The poor clinical outcomes with doxycycline therapy led to the use of azithromycin as the primary drug of choice. Single-dose azithromycin regimen over a period of time was changed to extended regimen following studies showing better clinical cures and less risk of resistance development. However, emerging macrolide resistance, either due to transmission of resistance or drug pressure has further worsened the management of this infection. The issues of drug resistance and treatment failures also exist in cases of infection. At present, the emergence of multidrug-resistant (MDR) strains is an alarming sign for its treatment and the associated public health impact due to its complications. However, newer drugs like pristinamycin, solithromycin, sitafloxacin, and others have shown a hope for the clinical cure, but need further clinical trials to optimize the therapeutic dosing schedules and formulate appropriate treatment regimens. Rampant and inappropriate use of these newer drugs will further sabotage future attempts to manage MDR strains. There is currently a need to formulate diagnostic algorithms and etiology-based treatment regimens rather than the syndromic approach, preferably using combination therapy instead of a monotherapy. Awareness about the current guidelines and recommended treatment regimens among clinicians and local practitioners is of utmost importance. Antimicrobial resistance testing and global surveillance are required to assess the efficacy of current treatment regimens and for guiding future research for the early detection and management of MDR infections.

摘要

是引起非淋菌性尿道炎的重要原因之一。发病率上升和新出现的抗菌药物耐药性是当前主要关注的问题。强力霉素治疗的临床效果不佳导致阿奇霉素被用作首选药物。经过一段时间,单剂量阿奇霉素治疗方案改为延长疗程方案,因为研究表明这样临床治愈率更高,产生耐药性的风险更低。然而,由于耐药性传播或药物压力导致的大环内酯类耐药性的出现,进一步恶化了这种感染的治疗情况。在感染病例中也存在耐药性和治疗失败的问题。目前,多重耐药菌株的出现对其治疗以及由于其并发症对公共卫生造成的相关影响来说是一个警示信号。然而,诸如普那霉素、索利霉素、西他沙星等新药已显示出临床治愈的希望,但还需要进一步的临床试验来优化治疗给药方案并制定合适的治疗方案。这些新药的滥用和不当使用将进一步破坏未来应对多重耐药菌株的努力。目前需要制定诊断算法和基于病因的治疗方案,而不是采用症状治疗方法,最好使用联合治疗而非单一疗法。临床医生和当地从业者了解当前指南和推荐的治疗方案至关重要。需要进行抗菌药物耐药性检测和全球监测,以评估当前治疗方案的疗效,并为指导未来关于多重耐药感染的早期检测和管理的研究提供依据。

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