Kanesaka Izumo, Kong Fabian Yuh Shiong, Vanbaelen Thibaut, Santhini Manoharan-Basil Sheeba, Kenyon Chris
STI Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
Department of Infection Control and Prevention, Faculty of Nursing, Toho University, Tokyo, Japan.
Expert Rev Anti Infect Ther. 2025 Jul;23(7):459-467. doi: 10.1080/14787210.2025.2505559. Epub 2025 May 19.
Ceftriaxone is the last available single dose therapy for gonorrhea that effectively treats infections at all sites. Over a quarter of isolates are now resistant to ceftriaxone in some countries. The introduction of carefully chosen combination therapy with ceftriaxone could retard the emergence of ceftriaxone resistance.
This review summarizes the findings of a PubMed search on the use of partner antimicrobial that could be used with ceftriaxone to prevent the emergence and spread of ceftriaxone resistance. We review 16 antimicrobials that could be partnered with ceftriaxone in terms of pharmacokinetic and pharmacodynamic compatibilities, activity against ceftriaxone resistant isolates and probability of antimicrobial resistance emerging.
Of these 16 antimicrobials, we reject antimicrobials such as fosfomycin due to poor clinical efficacy and tigecycline due to its considerably longer half-life which would likely select for tetracycline resistance. The most promising agents for combination with ceftriaxone are zoliflodacin, delafloxacin, sitafloxacin, eravacycline and possibly gepotidacin and gentamicin. Clinical studies should be conducted to evaluate the efficacy of these combinations on the eradication of N. gonorrhoeae and their impact on AMR in N. gonorrhoeae and other bacterial species.
头孢曲松是目前淋病唯一可用的单剂量疗法，可有效治疗所有部位的感染。在一些国家，超过四分之一的分离株对头孢曲松耐药。引入精心选择的与头孢曲松联合的治疗方法可能会延缓头孢曲松耐药性的出现。
本综述总结了PubMed上关于可与头孢曲松联合使用以预防头孢曲松耐药性出现和传播的伴侣抗菌药物使用情况的搜索结果。我们从药代动力学和药效学兼容性、对头孢曲松耐药分离株的活性以及出现抗菌药物耐药性的可能性等方面，对16种可与头孢曲松联合使用的抗菌药物进行了综述。
在这16种抗菌药物中，我们排除了临床疗效不佳的磷霉素等抗菌药物，以及半衰期长得多、可能会导致四环素耐药性的替加环素。与头孢曲松联合使用最有前景的药物是佐利氟达辛、德拉氟沙星、西他沙星、依拉环素，可能还有吉波达辛和庆大霉素。应开展临床研究，以评估这些联合用药对根除淋病奈瑟菌的疗效及其对淋病奈瑟菌和其他细菌物种抗菌药物耐药性的影响。
