ANALIZAN LA RESISTENCIA ANTIBIOTICA DE <I>NEISSERIA MENINGITIDIS</I>





ANALIZAN LA RESISTENCIA ANTIBIOTICA DE NEISSERIA MENINGITIDIS

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La ceftriaxona parece ser la opción más segura para su uso en la quimioprofilaxis de la enfermedad meningocócica.
Autor:
José Antonio Lepe Jiménez
Columnista Experto de SIIC

Institución:
Hospital Universitario Virgen del Rocío


Artículos publicados por José Antonio Lepe Jiménez
Coautor
Javier Aznar Martín* 
Doctor en Medicina. Especialista en Microbiología y Parasitología, Hospital Universitario Virgen del Rocío, Sevilla, España*
Recepción del artículo
29 de Julio, 2008
Aprobación
15 de Septiembre, 2008
Primera edición
11 de Marzo, 2009
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
La profilaxis antibiótica debe ser considerarse en personas con contacto con algún caso de enfermedad meningocócica o en poblaciones con altos porcentajes de portadores de N. meningitidis. El uso de antibioticos produce una reducción significativa del riesgo de enfermedad entre los contactos; así, la rifampicina, la ciprofloxacina y la ceftriaxona se consideran como las mejores opciones para la quimioprofilaxis, sin embargo su empleo está asociado con el aumento de resistencia antibiótica. Actualmente, la tendencia a la aparición de meningococos resistentes a la rifampicina después de la profilaxis es un aspecto reconocido, aunque parece que no es un fenómeno ampliamente extendido. La aparición de resistencia de alto nivel a la rifampicina está provocada por mutaciones en el gen rpoB, aunque se puede asociar a mutaciones del locus mtr implicadas en mecanismos de expulsión y bombeo. Sin embargo, los cambios en el gen rpoB dan lugar a cepas poco adaptadas a la supervivencia y este costo biológico podría explicar la ausencia de diseminación clonal de los aislamientos con resistencia adquirida a la rifampicina. La resistencia o sensibilidad disminuida a la ciprofloxacina se relaciona con mutaciones en la región determinante de resistencia a quinolonas (QRDR) del gen gyrA, además existen datos que apoyan la existencia de mecanismos de expulsión. Hasta el momento, la resistencia o la sensibilidad reducida a las quinolonas ha avanzado lentamente. No se han comunicado problemas de resistencia a la ceftriaxona, siendo la opción más segura para su uso en quimioprofilaxis. La espiramicina no es una opción adecuada aunque sigue siendo recomendada por la OMS.

Palabras clave
Neisseria meningitidis, antibióticos, resistencia, quimioprofilaxis, portadores


Artículo completo

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Abstract
The antibiotic prophylaxis should be considered for those in contact with any cases of meningococcal disease or in populations with high percentages of N. meningitidis carriers. The use of antibiotic treatment produces a significant reduction in the risk of disease among contacts. Currently, rifampin, ciprofloxacin and ceftriaxone are regarded as the best choice for chemoprophylaxis, but their use is associated with increased antibiotic resistance. Currently, the trend towards the emergence of meningococcal bacteria resistant to rifampicin after prophylaxis is a recognized, although it seems that it is not a widespread phenomenon. The emergence of high-level resistance to rifampicin is caused by mutations in the rpoB gene, although it appears that may be associated with mutations of locus mtr involved in pumping and expulsion mechanisms. However, changes in the rpoB gene lead to ill-suited strains to survival. This biological cost could explain the lack of clonal spread of the isolates with acquired resistance to rifampicin. The diminished sensitivity or resistance to ciprofloxacin, is linked to mutations in the region determinant of resistance to quinolones (QRDR) gyrA gene, in addition there are data that support the existence of expulsion mechanisms. So far, resistance or reduced sensitivity to quinolones has progressed slowly. There has been no reported problems ceftriaxone resistance, being the safest option for use in chemoprophylaxis. Spiramycin is not an appropriate option, but is still recommended by WHO.

Key words
Neisseria meningitidis, antibiotics, resistance, chemoprophylaxis, carriers


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Infectología
Relacionadas: Bioquímica, Diagnóstico por Laboratorio, Epidemiología, Farmacología, Medicina Farmacéutica, Medicina Interna, Pediatría



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José Antonio Lepe Jiménez, Hospital Universitario Virgen del Rocío Servicio de Microbiología, 41940, Estacada de Ochuela 22, Sevilla, España
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