Journal List > Korean J Urogenit Tract Infect Inflamm > v.8(2) > 1059935

Baik and Lim: Multidrug Resistance in Neisseria gonorrhoeae

Abstract

Gonorrhea, caused by Neisseria gonorrhoeae is the second most prevalent bacterial sexually transmitted infection. The disease causes serious reproductive complications such as pelvic inflammatory disease, ectopic pregnancy, and infertility, and can facilitate human immunodeficiency virus transmission. Numerous antimicrobial agents have been used for the treatment of gonorrhea since sulfanilamides were introduced in 1936. Unfortunately, N. gonorrhoeae readily develops resistance to antimicrobial agents. Strains with decreased susceptibility to oral third generation cephalosporin (cefixime) are currently emerging. The US Centers for Disease Control and Prevention (CDC) no longer recommends cefixime at any dose as a first-line regimen for treatment of gonococcal infections, but recommends combination therapy with ceftriaxone 250 mg intramuscularly and either azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days as the most reliably effective treatment for uncomplicated gonorrhea.

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Fig. 1.
Study on antimicrobial resistance of Neisseria gonorrhoeae isolated in Korea, 2008-2011.
kjutii-8-90f1.tif
Fig. 2.
Annual trend of cefixime minimum inhibitory concentrations of Neisseria gonorrhoeae isolated in Korea.
kjutii-8-90f2.tif
Fig. 3.
Annual trend of ceftriaxone minimum inhibitory concentrations of Neisseria gonorrhoeae isolated in Korea.
kjutii-8-90f3.tif
Table 1.
Recent changes of Centers for Disease Control and Prevention in treatment guidelines on gonococcal infection
Year Classification Recommended regimens Alternative regimens
200718 Uncomplicated gonococcal infections of the cervix, urethra, and rectum Ceftriaxone 125 mg IM in a single dose or cefixime 400 mg PO in a single dose PLUS 1 of the following: Azithromycin 1 g PO in single dosea or doxycycline 100 mg PO twice a day for 7 daysa Spectinomycin 2 g IM in a single dose or cephalosporin single dose regimens
  Uncomplicated gonococcal infections of the pharynx Ceftriaxone 125 mg IM in a single dose PLUS 1 of the following: Azithromycin 1 g PO in single dosea or doxycycline 100 mg PO twice a day for 7 daysa  
201032 Uncomplicated gonococcal infections of the cervix, urethra, and rectum Ceftriaxone 250 mg IM in a single dose or cefixime 400 mg PO in a single dose PLUS 1 of the following: Azithromycin 1 g PO in a single doseb or doxycycline 100 mg twice a day for 7 daysb Cefpodoxime 400 mg PO Spectinomycin 2 g IM in a single dose
      Azithromycin 2 g PO in a single doseb
  Uncomplicated gonococcal infections of the pharynx Ceftriaxone 250 mg IM in a single dose PLUS 1 of the following:  
    Azithromycin 1 g PO in a single doseb or doxycycline 100 mg twice a day for 7 daysb  
20123 Uncomplicated gonococcal infections of the cervix, urethra, and rectum Ceftriaxone 250 mg IM in a single dose PLUS 1 of the following: Cefixime 400 mg PO in a single dose PLUS 1 of the following:
    Azithromycin 1g PO in a single dose (preferred)b or doxycycline 100 mg twice a day for 7 daysb Azithromycin 1g PO in a single dose (preferred) or doxycycline 100 mg twice a day for 7 days and test-of-cure in 1 week
  Uncomplicated gonococcal infections of the pharynx Ceftriaxone 250 mg IM in a single dose PLUS 1 of the following:b  
    Azithromycin 1 g PO in a single dose (preferred)b or doxycycline 100 mg twice a day for 7 daysb  

a Treatment for chlamydia if chlamydial infection is not ruled out

b always treat with azithromycin or doxycycline even if client tested negative for Chlamydia.

Table 2.
2011 Korean guideline on gonococcal infection
Classification Recommended regimens Alternative regimens
Uncomplicated gonococcal infections of the cervix, urethra, and rectum Ceftriaxone 250 mg IM in a single dose or cefixime 400 mg PO in a single dose PLUS 1 of the following: Spectinomycin 2 g IM in a single dose PLUS 1 of the following:
  Azithromycin 1 g PO in single dosea or doxycycline 100 mg PO twice a day for 7 daysa Azithromycin 1 g PO in single dosea or doxycycline 100 mg PO twice a day for 7 daysa
Uncomplicated gonococcal infections of the pharynx Ceftriaxone 250 mg IM in a single dose PLUS 1 of the following:  
  Azithromycin 1 g PO in single dosea or doxycycline 100 mg PO twice a day for 7 daysa  

a Treatment for chlamydia if chlamydial infection is not ruled out.

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