抗生素的应用与耐药之间的

因果联系被确认

耐药的发生和后继的问题越来越被人重视。

其原因是不加控制的使用（滥用）抗生素可能会摧毁整个抗生素体系。

如《启示录》一样，此文有这样的目的。

（责任心和社会良知是医生应有品质。除此之外，还应有深入的眼光！）

相关链接：

 antibiotic use & resistance

抗生素的应用与耐药之间的因果联系被确认

2007-02-08 18:30:16 -0400 (Reuters Health)

NEW YORK (Reuters Health) - A causal link between exposure to antibiotics and antibiotic resistance has been confirmed, European researchers report in the February 10th issue of The Lancet.

纽约（路透社健康消息） 在2007年2月的第10期 柳叶刀杂志上报道：抗生素的应用与耐药之间的因果联系被确认

They also present evidence that the development of resistance to one class of antibiotic may confer persistent increased resistance to other antibiotic classes.

他们在此还提供了（另）一些证据表明：对一类抗生素的耐药的发展可以深远地影响到对另一种抗生素耐药的提升。

Studies have established an association between antimicrobial use and resistance, Dr. Herman Goossens of University Hospital Antwerp, Belgium, and his team note, but randomized, double-blind, placebo-controlled trials are needed to establish a causal link.

此项研究已确立了抗微生物（药）的应用与耐药性的关联。比利时安特卫普大学医院的Herman Goossens博士和他的研究小组认识到，一个随机、双盲、安慰剂对照组的试验对确立前一个因果关联是必要的。

　

Dr. Goossens' group evaluated the effect of two macrolides on commensal oral streptococci. These drugs are commonly used to treat respiratory tract infections, and resistance to macrolides in respiratory pathogens is increasing.

Dr. Goossens 工作组对两个用于口链球菌的大环内酯药的效果进行了评估。这两种药物常用于治疗呼吸道感染，现在，呼吸道病原体对他们的耐药性在升高。

Their trial included 347 healthy volunteers randomized to azithromycin, 500 mg q.d. for 3 days; clarithromycin, 500 mg b.i.d. for 7 days; or to two matching placebo groups. At baseline and periodically thereafter, a total of 1218 samples were obtained with pharyngeal swabs, stored in liquid medium, and then plated on streptococcus selective medium with or without erythromycin.

他们的试验对象是347个健康自愿者，随机化被分配给500mg的axithromycin 每天服用一次，连服三天；或者500mg的clarithromycin 每天服二次，连服7天；这两种人群安排了配对的安慰剂对照组。之后，一个基准的和周期的取样，共取1218份咽试子作为标本，储于液体培养基里，然后，在培养基被覆（一层）筛选过有和没有红霉素成分培养基的链球菌。

Resistance peaked at day 4 in the azithromycin group and at day 8 in the clarithromycin group, and remained significantly higher than in the placebo groups until the end of the study on day 180. The latter finding "emphasizes that the commensal flora could serve as a reservoir of resistance for potentially pathogenic bacteria," the authors note.

耐药锋出现在azithromycin组的第4天，clarithromycin组的第8天，直到试验结束后的180天里，两组均显著高于安慰剂对照组。后来的一些发现表明，重要的是共生的物种（正常菌群）作为耐药的宿主提供给潜在病原菌有用的信息（★★）。研究者如是说。

Taking into account subjects' age, gender, smoking status, previous antibiotic use, and hospital employment, "macrolide exposure was the strongest variable independently associated with the proportion of macrolide-resistant streptococci," the authors write.

考虑对下因素，如年龄、性别、吸烟与否、先前使用抗生素情况和医院的职工，暴露于大环内酯药物环境，对发生耐大环内酯药的比例，最强有力的独立影响因素，

Genetic analysis of strep isolates revealed that clarithromycin decreased carriage of the low- to moderate-resistance gene mef, which encodes a drug efflux pump. As a result, there was an increased population of isolates carrying the higher resistance gene erm(B).

基因分析链球菌的基因片断发现：clarithromycin降低了低－中度耐药基因mef携带，这些基因编码药物溢出泵。其结果，就是独立携带高耐药基因-erm(B)的比例升高了。

The erm(B) gene encodes a methylase that alters the macrolide binding site on the bacterial ribosome and is accompanied by the tetracycline resistance gene tet(M).

基因erm(B)编码了 methylase，它改变了大环内酯绑定细菌核糖体上的位置，并且它与tetracycliner耐药基因tet(M)相伴。

"Thus, erm(B) acquisition after clarithromycin therapy might restrict the use of not only all macrolides, but also of the lincosamides, streptogramins B, and tetracyclines," the researchers conclude.

于是，在 clarithromycin 治疗之后erm（B）获得可能限制的不仅是所有大环内酯类应用，还有lincosamides和streptogramins B及tetracyclines。研究人员作出如是分析。

In a related editorial, Dr. Stephanie J. Dancer, of Southern General Hospital in Glasgow, commends the trial and urges the medical community to "do something about (inappropriate and uncontrolled antibiotic prescribing) before the antibiotic era finally grinds to its apocalyptic halt."

在关的编者按中，Glasgow 的南方总医院的Dr Stephanine J Dancer ，给此文以褒奖，并极力主张那些医疗单位在在抗生素时代最后被碾碎之前，做些什么来着（不当和不加控制地使用抗生素），回应这个“启示”性文章。

Lancet 2007;369:442-443,482-490.

(来源)

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