Urethritis and antimicrobial resistance

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Abstract

Urethritis is a clinical syndrome which is characterized by mucopurulent or purulent urethral discharge with or without dysuria, due to an increased number of polymorphonuclear leukocytes in the anterior urethra. Antimicrobial therapy and preventive measures are essential in the management of bacterial urethritis. However, these drugs may cause antimicrobial resistance, resulting in unsuccessful treatment and complications of urethritis. Resistance of Neisseria gonorrhoeae to antibiotics is well known for decades, and in recent years there are more cases of resistance of Chlamydia trachomatis and Mycoplasma genitalium to different antibiotics. There is a danger that in the future certain strains of N. gonorrhoeae will be resistant to all available antimicrobial agents, unless new antibiotics to which resistance will not develop rapidly or an effective vaccine are developed.

Sažetak Uvod.

Uretritis je klinički sindrom za koji je karakteristična pojava mukopurulentnog ili purulentnog uretralnog sekreta, sa dizurijom ili bez nje, zbog povećanog broja polimorfonuklearnih leukocita u prednjoj uretri. Antimikrobna terapija i mere prevencije su osnova u borbi protiv bakterijskih uretritisa. Ovu borbu remeti antimikrobna rezistencija te je i terapija neuspešna, a postoji i mogućnost komplikacija uretritisa.

Neisseria gonorrhoeae. Tokom proteklih decenija mnogi antibiotici kojima su lečeni pacijenti oboleli od gonoreje, kao što su penicillin, tetraciklini, hinoloni i makrolidi, više nisu lekovi izbora. Danas su terapija izbora cefalosporini treće generacije. Prvi podaci o rezistenciji na cefalosporine objavljeni su u Japanu 2000. godine, što ukazuje na to da bi lečenje ove infekcije moglo da predstavlja veliki problem u budućnosti.

Mycoplasma i ureaplasma. U terapiji se primenjuju azitromicin i doksiciklin. Istraživanja pokazuju da je azitromicin superiorniji od doksiciklina, ali sa rizikom od razvoja azitromicin-indikovane rezistencije. Zbog toga danas nema opšteprihvaćene standardne terapije.

Chlamydia trachomatis. Prva linija terapije je primena azitromicina. Istraživanja pokazuju da je neuspeh terapije veći od ranije objavljenih 5% lečenih.

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Serbian Journal of Dermatology and Venereology

The Journal of Serbian Association of Dermatovenereologists (SAD)

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