Data for 2014 shows a worsening of gonorrhea susceptibility to recommended antibiotic treatments, according to a new study published in JAMA. These results oppose earlier findings that suggested a decline in antibiotic resistance over the past few years.
The Centers for Disease Control and Prevention (CDC) updates guidelines periodically based on resistance trends. In 2010, the CDC updated its single-dose cephalosporin (eg, injectable ceftriaxone, oral cefixime) recommendation to a higher dose of ceftriaxone or cefixime plus a second antibiotic. Then in 2012, the CDC updated recommendations again to a ceftriaxone-based combination therapy as the single recommended therapy.
In this study, trends in gonorrhea susceptibility to 3rd generation cephalosporin antibiotics were examined by Robert D. Kirkcaldy, MD, MPH, of the CDC, and colleagues. They analyzed data during 2006–2014 from the CDC’s Gonococcal Isolate Surveillance Project, which included data on antimicrobial susceptibility in urethral isolates from men with gonorrhea treated at public clinics. A total of 51,144 isolates were obtained in 34 cities.
Study data showed an increase in the percent of study patients treated with 250mg intramuscular (IM) ceftriaxone from 8.7% in 2006 to 96.6% in 2014. The percent of isolates with reduced cefixime susceptibility increased from 0.1% to 1.4% from 2006 to 2011, with a decline to 0.4% in 2013. Then in 2014, the percent of resistant isolates increased to 0.8%.
Study authors explained that a causal relationship cannot be established with an improvement in susceptibility changes with guideline changes, “The 2014 data, however, suggest that improvements in susceptibility may be short-lived,” added Dr. Kirkcaldy. Findings from the study show the need to maintain surveillance, discover new therapies, and make sure that treatment for gonorrhea aligns with the CDC’s guidelines.
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