Multidrug Resistance in Neisseria gonorrhoeae

Seung Baik; Dong Hoon Lim

doi:10.14777/kjutii.2013.8.2.90

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

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Baik and Lim: Multidrug Resistance in Neisseria gonorrhoeae

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Korean J Urogenit Tract Infect Inflamm 2013;8(2):90-97.

Published online: 17 October 2013

DOI: https://doi.org/10.14777/kjutii.2013.8.2.90

Multidrug Resistance in Neisseria gonorrhoeae

Seung Baik, Dong Hoon Lim

Department of Urology, School of Medicine, Chosun University, Gwangju, Korea

Correspondence to: Dong Hoon Lim, Department of Urology, School of Medicine, Chosun University, 309, Pilmun-daero, Dong-gu, Gwangju 501-759, Korea Tel: +82-62-220-3681, Fax: +82-62-232-3210 E-mail: dhlim@chosun.ac.kr

This study was supported by reserch funds from Chosun University Hospital 2012. No potential conflict of interest relevant to this article was reported.

Received 5 April 2013 Revised 18 April 2013 Accepted 16 May 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Drug resistance, Multiple, Cefixime, Gonorrhea, Neisseria gonorrhoeae

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Fig. 1.

Study on antimicrobial resistance of Neisseria gonorrhoeae isolated in Korea, 2008-2011.

Fig. 2.

Annual trend of cefixime minimum inhibitory concentrations of Neisseria gonorrhoeae isolated in Korea.

Fig. 3.

Annual trend of ceftriaxone minimum inhibitory concentrations of Neisseria gonorrhoeae isolated in Korea.

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 dose^a or doxycycline 100 mg PO twice a day for 7 days^a	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 dose^a or doxycycline 100 mg PO twice a day for 7 days^a
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 dose^b or doxycycline 100 mg twice a day for 7 days^b	Cefpodoxime 400 mg PO Spectinomycin 2 g IM in a single dose
			Azithromycin 2 g PO in a single dose^b
	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 dose^b or doxycycline 100 mg twice a day for 7 days^b
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 days^b	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 days^b

^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 dose^a or doxycycline 100 mg PO twice a day for 7 days^a	Azithromycin 1 g PO in single dose^a or doxycycline 100 mg PO twice a day for 7 days^a
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 dose^a or doxycycline 100 mg PO twice a day for 7 days^a

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

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