非青霉素类抗生素治疗梅毒的耐药现状及机制

Resistance of Treponema pallidum to non.penicillin antibiotics： present status and mechanisms

目前在梅毒的治疗上仍首选青霉素，由于青霉素存在药物过敏等问题，对这类患者，临床上常选用大环内酯类、四环素类和第三代头孢菌素作为替代治疗法，其中多西环素和头孢曲松因其具有较小的耐药性可作为首选的替代药物，但使用头孢曲松时应谨慎，因为可能存在和青霉素的交叉过敏。而大环内酯类抗生素，特别是阿奇霉素的临床耐药性较高，只能作为特殊情况下次选替代药物。梅毒螺旋体对各类替代药物的耐药性与药物的抗菌机制及某些梅毒螺旋体株型的基因突变有关。

Penicillin is the preferred drug for treating syphilis at present, although penicillin allergy has been a serious problem. For penicillin-allergic patients with syphilis, macrolides, tetracyclines and thirdgeneration cephalosporins can be applied. Of these alternatives, doxycycline and ceftriaxone can serve as the primary choice for their strong antimicrobial activity. However, ceftriaxone should be used with caution for the possible cross allergy with penicillin. Macrolides, especially azithromycin, can only serve as a second-line treatment in specific conditions for the high resistance rate in clinical practice. The resistance of Treponema pallidum to these alternative drugs is associated with antimicrobial mechanisms of drugs and gene mutations in some Treponema pallidum strains.