Erythromycin Failure in the Treatment of Syphilis in a Pregnant Woman

Hashisaki, Peter; Wertzberger, Geoffrey G.; Conrad, Gary L.; Nichols, Craig R.

doi:10.1097/00007435-198301000-00008

Cited by 44 publications

(18 citation statements)

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“…The finding of an erythromycin-resistant strain of T. pallidum is not necessarily surprising if past reports of erythromycin treatment failures in human patients with syphilis are considered (2,4,8,21), and it prompted us to investigate the origin of street strain 14. We subsequently learned in a personal communication from D. S. Kellogg (Centers for Disease Control, Atlanta, Ga.) that T. pallidum street strain 14 was isolated from a penicillin-allergic patient with an active case of secondary syphilis that had been unsuccessfully treated with erythromycin.…”

Section: Discussionmentioning

confidence: 99%

“…Tetracycline is contraindicated for young children and pregnant women (10), however, and erythromycin has been only marginally effective when a total dose of less than 30 g was administered over 2 weeks (2,4,21). Erythromycin treatment failures have also been documented when adequate therapy was given for primary syphilis (8), and congenital syphilis has occurred in infants whose mothers responded to this antibiotic (6,22).…”

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In vitro assay to demonstrate high-level erythromycin resistance of a clinical isolate of Treponema pallidum

Stamm

Stapleton

Bassford

1988

Antimicrob Agents Chemother

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We have previously demonstrated that cells of Treponema paUidum freshly extracted from infected rabbit testes can be intrinsically radiolabeled with [35S]methionine to very high specific activities. In this study we used the inhibition of [35S]methionine incorporation into trichloroacetic acid-precipitable protein in vitro as an assay to test the susceptibilities of three different pathogenic treponemal strains to various antibiotics. In general, the results correlated very well with the known efficacies of these antibiotics in treating human patients with syphilis. One of the strains tested, however, a clinical isolate of T. paUidum designated street strain 14, was found to exhibit high-level resistance to erythromycin and a closely related macrolide, roxithromycin (RU 965). Street strain 14 was originally isolated from a human patient with active secondary syphilis who failed to respond to erythromycin therapy. Thus, our results indicate that an erythromycin-resistant strain of T. paUidum can be responsible for erythromycin treatment failure. In addition, street strain 14 treponemes were found to be generally less susceptible by this assay to a variety of antibiotics than were treponemes of the T. pallidum Nichols strain. These findings suggest that the outer envelope of street strain 14 treponemes may be generally less permeable to antibiotics than is that of Nichols strain treponemes.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

In vitro assay to demonstrate high-level erythromycin resistance of a clinical isolate of Treponema pallidum

Stamm

Stapleton

Bassford

1988

Antimicrob Agents Chemother

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“…Different macrolide antibiotics interact with different regions of the 23S rRNA gene. 7 Failures of macrolide treatment of syphilis have been well documented in the literature [8][9][10][11][12][13][14][15][16][17][18] and included cases of erythromycin-clarithromycin-azithromycin-spiramycin treatment failures. Until now, no macrolide treatment failures in the treatment of yaws have been reported.…”

Section: Macrolide Failures In Syphilis Treatment and Frequency Of Mumentioning

confidence: 99%

Macrolide Resistance in the Syphilis Spirochete, Treponema pallidum ssp. pallidum: Can We Also Expect Macrolide-Resistant Yaws Strains?

Šmajs

Paštěková

Grillová

2015

The American Society of Tropical Medicine and Hygiene

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Abstract. Treponema pallidum ssp. pallidum (TPA) causes over 10 million new cases of syphilis worldwide whereas T. pallidum ssp. pertenue (TPE), the causative agent of yaws, affects about 2.5 million people. Although penicillin remains the drug of choice in the treatment of syphilis, in penicillin-allergic patients, macrolides have been used in this indication since the 1950s. Failures of macrolides in syphilis treatment have been well documented in the literature and since 2000, there has been a dramatic increase in a number of clinical samples with macrolide-resistant TPA. Scarce data regarding the genetics of macrolide-resistant mutations in TPA suggest that although macrolide-resistance mutations have emerged independently several times, the increase in the proportion of TPA strains resistant to macrolides is mainly due to the spread of resistant strains, especially in developed countries. The emergence of macrolide resistance in TPA appears to require a two-step process including either A2058G or A2059G mutation in one copy of the 23S rRNA gene and a subsequent gene conversion unification of both rRNA genes. Given the enormous genetic similarity that was recently revealed between TPA and TPE strains, there is a low but reasonable risk of emergence and spread of macrolide-resistant yaws strains following azithromycin treatment.

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“…Alternative antibiotics for nonpregnant penicillin-allergic patients with primary or secondary syphilis include doxycycline, tetracycline, or erythromycin. Erythromycin treatment failures have been documented in patients with primary or secondary syphilis and infants with congenital syphilis (2,3,5). We previously demonstrated high-level erythromycin resistance (Erm r ) in a T. pallidum clinical isolate (Street strain 14) obtained from a syphilis patient who failed erythromycin therapy (11).…”

mentioning

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A Point Mutation Associated with Bacterial Macrolide Resistance Is Present in Both 23S rRNA Genes of an Erythromycin-Resistant Treponema pallidum Clinical Isolate

Stamm

Bergen

2000

Antimicrob Agents Chemother

114

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Erythromycin Failure in the Treatment of Syphilis in a Pregnant Woman

Cited by 44 publications

References 0 publications

In vitro assay to demonstrate high-level erythromycin resistance of a clinical isolate of Treponema pallidum

In vitro assay to demonstrate high-level erythromycin resistance of a clinical isolate of Treponema pallidum

Macrolide Resistance in the Syphilis Spirochete, Treponema pallidum ssp. pallidum: Can We Also Expect Macrolide-Resistant Yaws Strains?

A Point Mutation Associated with Bacterial Macrolide Resistance Is Present in Both 23S rRNA Genes of an Erythromycin-Resistant Treponema pallidum Clinical Isolate

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