日本第四代喹诺酮类抗生素：甲磺酸加雷沙星可能是未来治疗耐药生殖支原体的替代品（转发并编辑）

作者按：未来耐西他沙星菌株的生殖支原体可能流行，对此，有日本学者提出加雷沙星作为替代品：

西他沙星（STFX）是抗阿奇霉素生殖器支原体（MG）的替代疗法，而耐STFX的MG最近出现。因此，需要针对非衣原体非淋球菌性尿道炎（NGU）的另一种抗菌方案。Garenoxacin（GRNX，作者注加加雷沙星）是一种氟喹诺酮类药物，可预防呼吸道感染，在日本并非针对尿道炎，但已知其对MG的体外抗菌活性与莫西沙星相似或更高。为了阐明GRNX对抗MG的效率，我们检查了GRNX对NGU的临床疗效。招募了79名NGU男性患者，每天接受GRNX治疗一次，持续7天。为了评估微生物学和临床效果，细菌包括沙眼衣原体（CT），MG，人支原体（MH），通过治疗前和治疗后的核酸扩增试验检测到解脲脲原体（UU）和小尿素（UP，作者注，微小脲原体）。排除3例患者后，评估了76例患者：中位年龄；31（20-61）岁，阴道感染（66％）；最常见的传染途径和商业性工作者（43％）；最常见的来源。NGU细菌阳性50例，其中10例是多种细菌感染。临床治愈率为85.7％（36/42）。每种细菌的检测频率与先前报道的相似。CT，MG，MH，UU和UP的根除率分别为96.1％，71.4％，100％，85.7％和100％。这些结果表明，除了MG之外，GRNX对NGU具有优异的功效。耐药MG尿道炎的进一步研究；例如，对GRNX长期(如2周)用药的临床有效性或替代治疗方案的有效性的研究是必要的。

商品名称: Geninax甲磺酸加雷沙星片，每片200mg，每次400毫克，每天一次。

Journal of Infection and Chemotherapy ( IF 2.065 ) Pub Date : 2019-11-19 , DOI: 10.1016/j.jiac.2019.10.011

Hiroki Yamada 1 , Hiroshi Kiyota 1 , Shin Ito 2 , Takahide Hosobe 3 , Yutaka Shiono 4 , Katsuhisa Endo 5 , Shoichi Onodera 6 , Shin Egawa 7

1、Department of Urology, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo, 125-8506, Japan.

2、iClinic, 5-9-6 Nagamachi, Taihaku-ku, Sendai, Miyagi, 982-0011, Japan.

3、Hosobe Clinic, 1-1-15 Nezu, Bunkyo-ku, Tokyo, 113-0031, Japan.

4、Aioi23 Clinic, 1-3 Aioicho, Yokohama Nana-ku, Kanagawa, 231-0012, Japan.

5、Department of Urology, JR Tokyo General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan.

6、Koyama Rehabilitation Hospital, 405-25 Obuchi, Fuji, Shizuoka, 417-0801, Japan.

7、Department of Urology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.

英文原文

Sitafloxacin (STFX) is an alternative treatment against azithromycin-resistant Mycoplasma genitalium (MG), whereas STFX-resistant MG have appeared recently. Therefore, another antimicrobial regimen for non-chlamydial non-gonococcal urethritis (NGU) is required. Garenoxacin (GRNX) is a fluoroquinolone against respiratory infections, not against urethritis in Japan, but its in-vitro antimicrobial activity against MG is known as similar to or higher than that of moxifloxacin. To clarify the efficiency of GRNX against MG, we examined the clinical efficacy of GRNX for NGU. Seventy-nine male patients with NGU were enrolled and treated with GRNX once daily for 7 days. For assessing microbiological and clinical efficacies, the bacteria including Chlamydia trachomatis (CT), MG, Mycoplasma hominis (MH), Ureaplasma urealyticum (UU) and Ureaplasma parvum (UP) were detected by means of nucleic acid amplification tests before- and after-treatment. After excluded 3 patients, seventy-six patients were evaluated: the median age; 31 (20-61) years, vaginal infection (66%); the most common infectious route and commercial sex worker (43%); the most common source. There were 50 bacteria-positive NGU cases, including 10 multiple bacterial infections. Clinical cure rate was 85.7% (36/42). Detection frequency of each bacterium was similar to the previous reported. The eradication rates of CT, MG, MH, UU and UP were 96.1%, 71.4%, 100%, 85.7% and 100%, respectively. These results indicate that GRNX has the excellent efficacies for NGU except those of MG. Further study of drug-resistant MG urethritis; for instance, studies on the clinical effectiveness of long-term such as 2-week medication of GRNX or the efficacy of alternative treatment regimens are necessary.