Objective: To evaluate clinical efficacy data for gentamicin in the treatment of gonorrhea. Data Sources: A keyword search of PubMed (1966 to April 2020), EMBASE (1947 to April 2020), and International Pharmaceutical Abstracts (1970 to April 2020) was conducted. The electronic search was supplemented with manual screening of references from identified articles and a search of ClinicalTrials.gov to identify ongoing trials. Study Selection and Data Extraction: Comparator and noncomparator studies reporting microbiological outcomes of treatment with gentamicin for gonorrhea in humans were included. Data extracted included study year, authors, aim, setting, population, dosing protocols, and outcome results. Risk of bias was assessed according to the Cochrane Risk of Bias Assessment Tool. Data Synthesis: A total of 407 articles were identified, of which 11 met inclusion criteria. Two studies were randomized controlled trials, and 1 additional randomized noncomparator study was identified. All other studies were nonrandomized and noncomparator in nature. The highest quality evidence suggests that gentamicin is not noninferior to ceftriaxone (both in addition to azithromycin) for treatment of gonorrhea but may achieve cure rates >90%. Conflicting evidence exists regarding the efficacy of gentamicin-based regimens for the specific treatment of extragenital gonorrhea. Relevance to Patient Care and Clinical Practice: Results of this review could affect patient care and clinical practice because they clearly demonstrate the role of gentamicin for the treatment of gonorrhea as a second-line agent. Future research should confirm findings, especially for the role of gentamicin in extragenital infections. Conclusions: Gentamicin-based regimens should be reserved for second-line treatment of urogenital and extragenital gonorrhea infections.

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使用庆大霉素治疗泌尿生殖道和生殖器外淋病：疗效数据的系统评价

目的：评价庆大霉素治疗淋病的临床疗效数据。数据来源：对 PubMed（1966 年至 2020 年 4 月）、EMBASE（1947 年至 2020 年 4 月）和 International Pharmaceutical Abstracts（1970 年至 2020 年 4 月）进行了关键字搜索。电子搜索辅以手动筛选已识别文章的参考文献和搜索 ClinicalTrials.gov 以识别正在进行的试验。研究选择和数据提取：包括比较和非比较研究报告庆大霉素治疗人类淋病的微生物结果。提取的数据包括研究年份、作者、目的、环境、人群、给药方案和结果。根据 Cochrane 偏倚风险评估工具评估偏倚风险。数据综合：共识别出407篇文章，其中11项符合纳入标准。两项研究是随机对照试验，另外还确定了 1 项随机非对照研究。所有其他研究本质上都是非随机和非比较的。最高质量的证据表明，庆大霉素在治疗淋病方面并非不劣于头孢曲松（两者均与阿奇霉素一起），但可达到 >90% 的治愈率。关于基于庆大霉素的方案对生殖器外淋病的特异性治疗的有效性，存在相互矛盾的证据。与患者护理和临床实践的相关性：本综述的结果可能会影响患者护理和临床实践，因为它们清楚地证明了庆大霉素作为二线药物治疗淋病的作用。未来的研究应该证实发现，特别是庆大霉素在生殖器外感染中的作用。结论：基于庆大霉素的方案应保留用于泌尿生殖道和生殖器外淋病感染的二线治疗。