Bojar R A, Eady E A, Jones C E, Cunliffe W J, Holland K T
Department of Microbiology, University of Leeds, U.K.
Br J Dermatol. 1994 Mar;130(3):329-36. doi: 10.1111/j.1365-2133.1994.tb02929.x.
Propionibacteria resistant to high concentrations of erythromycin [minimal inhibitory concentration (MIC) > or = 0.5 mg/ml] are now commonly isolated from the skin of antibiotic-treated acne patients. This double-blind study was carried out to assess the ability of 4% w/v erythromycin with and without 1.2% w/v zinc acetate to reduce the numbers of erythromycin-resistant propionibacteria in vivo, and also to monitor the acquisition of resistant strains de novo during therapy. Under laboratory conditions, erythromycin-resistant propionibacteria were shown to be as sensitive to zinc acetate as fully sensitive strains. In vivo, the erythromycin/zinc complex and erythromycin alone produced highly significant reductions in total propionibacteria (P < 0.001) and in the number of erythromycin-resistant strains (P < 0.001 at 8 weeks). After 12 weeks, resistant propionibacteria were reacquired, or acquired de novo, by three patients treated with erythromycin alone and four patients treated with the erythromycin/zinc complex. In contrast, changes in numbers of Micrococcaceae were slight and, after 12 weeks, erythromycin-resistant strains were predominant in both treatment groups. In vitro MIC determinations suggested that this finding might be explained by the exceptionally high degree of erythromycin resistance displayed by some staphylococcal strains (MIC > 4 mg/ml) and by the relative insensitivity of all staphylococcal strains to zinc acetate. Erythromycin with and without zinc was clinically effective, and both preparations produced significant reductions in acne grade, and inflamed and non-inflamed lesion counts (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
现在，经常从接受过抗生素治疗的痤疮患者皮肤中分离出对高浓度红霉素耐药的丙酸杆菌[最低抑菌浓度（MIC）≥0.5mg/ml]。本双盲研究旨在评估含和不含1.2%w/v醋酸锌的4%w/v红霉素在体内减少耐红霉素丙酸杆菌数量的能力，并监测治疗期间新出现的耐药菌株。在实验室条件下，耐红霉素丙酸杆菌对醋酸锌的敏感性与完全敏感菌株相同。在体内，红霉素/锌复合物和单独使用红霉素均使总丙酸杆菌数量（P<0.001）和耐红霉素菌株数量（8周时P<0.001）显著减少。12周后，单独使用红霉素治疗的3例患者和使用红霉素/锌复合物治疗的4例患者重新获得或新出现了耐药丙酸杆菌。相比之下，微球菌科数量变化轻微，12周后，两个治疗组中耐红霉素菌株均占主导。体外MIC测定表明，这一发现可能是由于一些葡萄球菌菌株对红霉素的耐药程度极高（MIC>4mg/ml）以及所有葡萄球菌菌株对醋酸锌相对不敏感所致。含锌和不含锌的红霉素在临床上均有效，两种制剂均使痤疮分级、炎性和非炎性皮损计数显著降低（P<0.001）。（摘要截短于250字）
