Department of Medical Microbiology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Bahir Dar, Ethiopia.
Antimicrob Resist Infect Control. 2020 Aug 18;9(1):138. doi: 10.1186/s13756-020-00805-7.
Gonorrhea is the second most common sexually transmitted bacterial infection (STI) next to Chlamydia. Untreated cases could results in major complications like pelvic inflammatory disease (PID), ectopic pregnancy, infertility, miscarriage, fetal death and congenital infections. Gonorrhea has been treated with antibiotics for more than eight decades. However, the emergence and spread of antimicrobial resistance (AMR) in gonococcus seriously compromises the management of the disease. The aim of this review was to describe the current developments in the field of azithromycin resistant gonococci.
Literatures published in English in the last 10 years were retrieved from PubMed, SCOPUS, Google scholar, Cochrane library and the Google databases using relevant searching terms.
Gonococcus is capable of using a number of strategies to confer resistance as the bacterium has an extraordinary capacity to alter its genome. So far the accumulated data on the field showed that the world is heading towards a pandemic of extensively drug-resistant (XDR) gonococcus which is now seems to be evolving into a true "superbug". Hence, in the near future gonorrhea may become untreatable on the international basis unless new drugs become available. An antibiotic resistance in gonococcus has been noted beginning in 1940s against sulfonamides. Since then, resistance has rapidly emerged to penicillins, tetracyclines, macrolides, fluoroquinolones, and cephalosporins. Currently, in most nations, the injectable extended-spectrum cephalosporin (ESC), i.e. ceftriaxone based therapy is the only remaining option for gonorrhea. Based on the WHO and the US-CDC recommendations, countries are increasingly using a combination of cephalosporin and azithromycin for the treatment of gonorrhoea. Azithromycin revolutionized gonoccocal therapy as it shortened treatment time by more than half from 7 to 14 days and improved patient compliance due to high tissue levels and long half-life. However, constantly emerging reports from different parts of the globe showed that N. gonorrhoeae is developing significant level of resistance against azithromycin, and so far more than 33% level of resistance was reported. Two strategies have been commonly implicated in gonococcal resistance against azithromycin: over expression of an efflux pump (due to mutations at mtrR coding region) and decreased antimicrobial affinity (due to mutations in genes encoding the 23S ribosomal subunit).
With no alternative antimicrobial treatment options for gonorrhoea and only a few new drugs in the development pipeline, it is necessary to monitor drug resistance and optimize treatment regimens regularly. Moreover, investigations for novel drugs should be wired.
淋病是仅次于衣原体的第二大常见性传播细菌感染（STI）。未经治疗的病例可能会导致严重的并发症，如盆腔炎（PID）、宫外孕、不孕、流产、胎儿死亡和先天性感染。淋病已经用抗生素治疗了 80 多年。然而，淋球菌对抗微生物药物的耐药性（AMR）的出现和传播严重影响了该病的管理。本综述的目的是描述阿奇霉素耐药淋球菌领域的最新进展。
从 PubMed、SCOPUS、Google 学术、Cochrane 图书馆和 Google 数据库中检索了过去 10 年以英文发表的文献，并使用相关搜索词进行检索。
淋球菌具有多种耐药策略，因为它具有改变其基因组的非凡能力。到目前为止，该领域积累的数据表明，世界正在走向广泛耐药（XDR）淋球菌的流行，现在这种菌似乎正在演变成一种真正的“超级细菌”。因此，除非有新的药物问世，否则在不久的将来，淋病可能在国际范围内无法治愈。自 20 世纪 40 年代以来，人们已经注意到淋球菌对抗磺胺类药物的抗生素耐药性。从那时起，耐药性迅速出现在青霉素、四环素、大环内酯类、氟喹诺酮类和头孢菌素类药物中。目前，在大多数国家，注射用扩展谱头孢菌素（ESC），即基于头孢曲松的治疗是淋病的唯一选择。根据世界卫生组织和美国疾病控制与预防中心的建议，各国越来越多地将头孢菌素和阿奇霉素联合用于淋病的治疗。阿奇霉素彻底改变了淋病的治疗，将治疗时间从 7 天缩短到 14 天以上，并且由于组织水平高和半衰期长，提高了患者的依从性。然而，来自全球不同地区的不断出现的报告表明，淋病奈瑟菌对阿奇霉素的耐药性显著增加，目前报告的耐药性超过 33%。两种策略通常与淋球菌对阿奇霉素的耐药性有关：一种是外排泵的过度表达（由于 mtrR 编码区的突变），另一种是抗菌亲和力降低（由于编码 23S 核糖体亚基的基因突变）。
由于淋病没有替代的抗菌治疗选择，而新的药物在研发管道中只有少数几种，因此有必要定期监测药物耐药性并优化治疗方案。此外，应该研究新型药物。
