National Infection Service, Public Health England, London NW9 5EQ, UK.
Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
J Antimicrob Chemother. 2021 Apr 13;76(5):1215-1220. doi: 10.1093/jac/dkaa559.
Neisseria gonorrhoeae has developed resistance to all antimicrobials used to treat gonorrhoea, with even ceftriaxone being undermined. It is therefore important to examine any potential to redeploy older antimicrobials routinely used for other infections to treat ceftriaxone-resistant gonococcal infections.
We examined the susceptibility of N. gonorrhoeae to aztreonam, chloramphenicol, co-trimoxazole, fosfomycin, piperacillin/tazobactam and rifampicin.
N. gonorrhoeae isolates (n = 94) were selected to include a range of antimicrobial susceptibilities: 58 were collected in the Gonococcal Resistance to Antimicrobials Surveillance Programme; 17 were clinical isolates referred to the PHE reference laboratory; and 19 were control strains. MICs were determined by agar dilution for the six study antimicrobials and for ceftriaxone and azithromycin as comparators.
There was correlation between piperacillin/tazobactam and ceftriaxone MICs, but all five isolates with high ceftriaxone MICs (>0.5 mg/L) were inhibited by piperacillin/tazobactam at 0.06-0.5 mg/L. Aztreonam MICs for ceftriaxone-resistant isolates exceeded those of ceftriaxone. Among non-β-lactams, fosfomycin and co-trimoxazole had low, tightly clustered MICs, suggesting widespread susceptibility, rifampicin split the collection into highly susceptible and highly resistant groups and chloramphenicol had a wide MIC distribution.
Although unsuitable for empirical use, piperacillin/tazobactam, fosfomycin, co-trimoxazole, rifampicin and, possibly, chloramphenicol could be considered for individual patients with ceftriaxone-resistant gonococcal infection once MICs are known. Wider surveillance of the susceptibility of N. gonorrhoeae to these agents is needed, along with clinical trials and the establishment of clinical breakpoints for N gonorrhoeae.
淋病奈瑟菌已对所有用于治疗淋病的抗菌药物产生耐药性，甚至包括头孢曲松。因此，有必要研究重新利用其他感染常规使用的旧抗菌药物来治疗头孢曲松耐药淋病奈瑟菌感染的潜力。
我们检测了淋病奈瑟菌对氨曲南、氯霉素、复方磺胺甲噁唑、磷霉素、哌拉西林/他唑巴坦和利福平的敏感性。
选择了 94 株淋病奈瑟菌分离株，以包括一系列抗菌药物敏感性：58 株来自抗菌药物耐药监测计划；17 株是临床分离株，送至 PHE 参考实验室；19 株是对照菌株。采用琼脂稀释法测定 6 种研究抗菌药物以及头孢曲松和阿奇霉素的 MIC。
哌拉西林/他唑巴坦与头孢曲松 MIC 之间存在相关性，但所有 5 株头孢曲松 MIC 较高（>0.5mg/L）的分离株均被哌拉西林/他唑巴坦在 0.06-0.5mg/L 时抑制。头孢曲松耐药分离株的氨曲南 MIC 高于头孢曲松。在非β-内酰胺类药物中，磷霉素和复方磺胺甲噁唑的 MIC 较低且紧密聚集，提示广泛的敏感性；利福平将分离株分为高度敏感和高度耐药两组；氯霉素的 MIC 分布较广。
虽然不适合经验性使用，但在了解 MIC 后，哌拉西林/他唑巴坦、磷霉素、复方磺胺甲噁唑、利福平，可能还有氯霉素，可以考虑用于治疗头孢曲松耐药淋病奈瑟菌感染的个别患者。需要对这些药物的淋病奈瑟菌敏感性进行更广泛的监测，同时还需要开展临床试验和建立淋病奈瑟菌的临床折点。
