Hof H, Kretschmar M
Institut für Med. Mikrobiologie und Hygiene, Fakultät für Klinische Medizin Mannheim, Universität Heidelberg.
Leber Magen Darm. 1994 Mar;24(2):57-8, 61-4.
One prerequisite for an effective treatment of a salmonella enteritis with antibiotics is a reliable direct antibacterial activity of the drug. In comparison to most of all other usual antibiotics quinolones, especially ciprofloxacin, fulfill these conditions, because its activity is high and resistance of Salmonella against quinolones is extremely rare. Since quinolone resistance is never plasmid coded, there will be even in the future no obvious risk of spreading of resistant strains. Another prerequisite is that the drug is able to have access to the site of residence of the microorganism. Salmonella spp. possess the virtue to penetrate into host cells and to reside and even to multiply there. Curing can be achieved only when these intracellular bacteria are eradicated. Elimination of Salmonella in the gut lumen alone is not satisfactory. Only few antibiotics are taken up into host cells, which could explain the rather frequent failure rate of antibiotic therapy of salmonella enteritis. Quinolones on the other hand are accumulated in host cells and in addition are able to act upon bacteria in this peculiar intracellular environment. Among the various quinolone derivatives ciprofloxacin is particularly qualified because it is excreted via the intestine to a considerable extent, so that high concentrations may be achieved at the proper site. The clinical experience demonstrates indeed that in most instances a rapid amelioration of the acute disease is achieved and in chronic carriers a high rate of curing occurs. Thus, for microbiological, pharmacological, and clinical reasons one can recommend ciprofloxacin for the treatment of enteric infections with Salmonella spp.
用抗生素有效治疗沙门氏菌肠炎的一个前提条件是药物具有可靠的直接抗菌活性。与大多数其他常用抗生素相比，喹诺酮类药物，尤其是环丙沙星，满足这些条件，因为其活性高，沙门氏菌对喹诺酮类药物的耐药性极为罕见。由于喹诺酮类耐药性从不由质粒编码，即使在未来也不会有耐药菌株传播的明显风险。另一个前提条件是药物能够到达微生物的驻留部位。沙门氏菌属具有侵入宿主细胞并在其中驻留甚至繁殖的特性。只有根除这些细胞内细菌才能实现治愈。仅消除肠道腔内的沙门氏菌并不令人满意。只有少数抗生素能进入宿主细胞，这可以解释沙门氏菌肠炎抗生素治疗失败率相当高的原因。另一方面，喹诺酮类药物在宿主细胞中蓄积，此外还能在这种特殊的细胞内环境中作用于细菌。在各种喹诺酮衍生物中，环丙沙星特别适用，因为它在很大程度上通过肠道排泄，因此在合适的部位可以达到高浓度。临床经验确实表明，在大多数情况下，急性疾病能迅速改善，慢性携带者的治愈率也很高。因此，出于微生物学、药理学和临床原因，对于沙门氏菌属引起的肠道感染，可推荐使用环丙沙星进行治疗。
