From the David Geffen School of Medicine at University of California Los Angeles.
Sex Transm Dis. 2021 Jun 1;48(6):385-392. doi: 10.1097/OLQ.0000000000001334.
Neisseria gonorrhoeae infections are becoming increasingly resistant to recommended treatments. Resistance-guided therapy may mitigate the continued emergence of resistance by enabling the use of previously recommended treatments like ciprofloxacin. To describe the effectiveness of ciprofloxacin to treat "susceptible" infections, we estimated the clinical efficacy of ciprofloxacin at various minimum inhibitory concentrations (MICs) and anatomic sites.
We reviewed publicly available reports using the PubMed.gov database and search terms "gonorrhea/drug therapy"[Mesh] AND "ciprofloxacin". We included clinical treatment studies in which ciprofloxacin was administered alone to treat N. gonorrhoeae, specimens were collected for N. gonorrhoeae culture from each infection, the MIC was determined for ≥90% of infective strains, and individual treatment outcomes were clearly defined. We recorded those data, ciprofloxacin dose and infection site. We calculated the frequency of treatment success and 95% confidence intervals (CIs).
Twenty studies from 1985 to 2020 met our inclusion criteria. Ciprofloxacin at commonly used doses eliminated 99.2% (95% CI, 98.5%-99.6%; n = 1439) of gonococcal infections with MICs <0.125 μg/mL, 76.3% (95% CI, 59.8%-88.6%; n = 38) of infections with MICs from 0.125 to 0.5 μg/mL, and 30.1% (95% CI, 20.5%-41.2%; n = 83) of infections with MICs ≥1 μg/mL across anatomic sites.
Ciprofloxacin reliably eliminated gonococcal infections with MICs <0.125 μg/mL across anatomic sites. Molecular assays predicting MICs of ciprofloxacin <0.125 μg/mL of gonococcal strains can allow for reintroduction of ciprofloxacin in gonorrhea treatment. Clinicians can confidently use ciprofloxacin to treat susceptible gonococcal infections.
淋病奈瑟菌感染对推荐的治疗方法越来越具有耐药性。耐药指导治疗可以通过使用以前推荐的治疗方法（如环丙沙星）来减轻耐药性的持续出现。为了描述环丙沙星治疗“敏感”感染的有效性，我们估计了环丙沙星在不同最低抑菌浓度（MIC）和解剖部位的临床疗效。
我们使用 PubMed.gov 数据库和搜索词“淋病/药物治疗”[Mesh] AND “环丙沙星”，审查了公开可用的报告。我们纳入了单独使用环丙沙星治疗淋病奈瑟菌的临床治疗研究，从每个感染部位采集淋病奈瑟菌培养标本，确定了≥90%感染株的 MIC，并明确了个体治疗结果。我们记录了这些数据、环丙沙星剂量和感染部位。我们计算了治疗成功率和 95%置信区间（CI）的频率。
从 1985 年到 2020 年，有 20 项研究符合我们的纳入标准。常用剂量的环丙沙星消除了 MIC<0.125μg/mL 的 99.2%（95%CI，98.5%-99.6%；n=1439）的淋球菌感染、MIC 为 0.125-0.5μg/mL 的 76.3%（95%CI，59.8%-88.6%；n=38）的感染和 MIC≥1μg/mL 的 30.1%（95%CI，20.5%-41.2%；n=83）的感染，遍布解剖部位。
环丙沙星可靠地消除了 MIC<0.125μg/mL 的淋球菌感染，遍布解剖部位。预测淋病奈瑟菌菌株 MIC<0.125μg/mL 的分子检测可以重新引入环丙沙星治疗淋病。临床医生可以有信心地使用环丙沙星治疗敏感的淋病奈瑟菌感染。
