Oppenheim B A
Public Health Laboratory, Withington Hospital, West Didsbury, Manchester, United Kingdom.
Clin Infect Dis. 1997 Jan;24 Suppl 1:S98-101. doi: 10.1093/clinids/24.supplement_1.s98.
Penicillin has long been recognized as the antibiotic of choice for treatment of meningococcal infections, but clinicians have recently become concerned about the susceptibility of meningococci to penicillin and other antibiotics used in the management of meningococcal disease. Strains relatively resistant to penicillin (minimum inhibitory concentrations ranging from 0.1 mg/L to 1.28 mg/L) have been reported from a large number of countries, although the frequency with which such isolates are found varies widely. The mechanism of relative resistance to penicillin involves, at least in part, the production of altered forms of one of the penicillin-binding proteins. Although treatment with penicillin is still effective against these relatively resistant strains, there is evidence that low-dose treatment regimens can fail. beta-Lactamase production in meningococci is extremely rare but has been reported, and this finding is of great concern. Resistance to sulfonamides and rifampin is of particular concern in regard to the management of contacts of patients with meningococcal disease.
长期以来，青霉素一直被公认为治疗脑膜炎球菌感染的首选抗生素，但临床医生最近开始担心脑膜炎球菌对青霉素及用于治疗脑膜炎球菌病的其他抗生素的敏感性。尽管在许多国家都报告了对青霉素相对耐药的菌株（最低抑菌浓度范围为0.1毫克/升至1.28毫克/升），但其发现频率差异很大。对青霉素相对耐药的机制至少部分涉及一种青霉素结合蛋白的变异形式的产生。尽管用青霉素治疗对这些相对耐药的菌株仍然有效，但有证据表明低剂量治疗方案可能无效。脑膜炎球菌产生β-内酰胺酶极为罕见，但已有报告，这一发现令人极为担忧。在处理脑膜炎球菌病患者的接触者时，对磺胺类药物和利福平的耐药性尤其令人担忧。
