Zenilman J M
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
Sex Transm Dis. 1996 May-Jun;23(3):213-8. doi: 10.1097/00007435-199605000-00009.
Single-dose, oral quinolones have been a recommended treatment option for gonorrhea since 1989 and have since been used as first-line therapy for gonorrhea in Baltimore.
The impact of this strategy on antimicobial susceptibility patterns in Neisseria gonorrhoeae was assessed utilizing data collected as part of the National Gonococcal Isolate Surveillance system. This system evaluates a systematically collected sample. Minimum inhibitory concentrations to penicillin, tetracycline, ceftriaxone, and ciprofloxacin were determined by agar dilution.
Between January 1988 and September 1994, 1,846 gonococcal isolates were evaluated. The proportion of isolates with plasmid-mediated resistance (penicillinase-producing Neisseria gonorrhoeae or tetracycline-resistant Neisseria gonorrhoeae) increased from 22% in 1988 to 46% in 1992 and then dropped to 20% in 1994. In contrast, the prevalence of chromosomally mediated resistant isolates ranged between 3% and 10%. Between 1988 and 1994, the geometric mean penicillin and tetracycline minimum inhibitory concentrations decreased slightly (penicillin: from 0.509 microgram/ml to 0.369 microgram/ml; tetracycline: from 1.01 micrograms/ml to 0.767 microgram/ml). The mean ceftriaxone MIC increased from 0.005 microgram/ml in 1988 to 0.021 microgram/ml in 1992, and then abruptly decreased. Ciprofloxacin minimum inhibitory concentrations did not change substantially during the study period. Concurrent studies performed in this community suggest that quinolones were infrequently used for infections other than sexually transmitted ones during this time period.
Single-dose quinolone therapy does not appear to foster development of resistant gonococcal isolates. However, resistance may develop as a result of complex ecological interactions with the community, underscoring the need for continued surveillance.
自1989年以来，单剂量口服喹诺酮类药物一直是淋病的推荐治疗选择，此后在巴尔的摩被用作淋病的一线治疗药物。
利用作为国家淋球菌分离株监测系统一部分收集的数据，评估该策略对淋病奈瑟菌抗菌药物敏感性模式的影响。该系统评估系统收集的样本。通过琼脂稀释法测定对青霉素、四环素、头孢曲松和环丙沙星的最低抑菌浓度。
在1988年1月至1994年9月期间，对1846株淋球菌分离株进行了评估。具有质粒介导耐药性（产青霉素酶淋病奈瑟菌或四环素耐药淋病奈瑟菌）的分离株比例从1988年的22%增加到1992年的46%，然后在1994年降至20%。相比之下，染色体介导耐药分离株的患病率在3%至10%之间。在1988年至1994年期间，青霉素和四环素的几何平均最低抑菌浓度略有下降（青霉素：从0.509微克/毫升降至0.369微克/毫升；四环素：从1.01微克/毫升降至0.767微克/毫升）。头孢曲松的平均最低抑菌浓度从1988年的0.005微克/毫升增加到1992年的0.021微克/毫升，然后突然下降。在研究期间，环丙沙星的最低抑菌浓度没有显著变化。在该社区进行的同期研究表明，在此期间喹诺酮类药物很少用于性传播感染以外的其他感染。
单剂量喹诺酮治疗似乎不会促进耐药淋球菌分离株的产生。然而，由于与社区的复杂生态相互作用，耐药性可能会出现，这突出了持续监测的必要性。
