Susceptibility to cephalosporins Neisseria gonorrhoeae in the United States - results of a 10-year observational study
Neisseria gonorrhoeae is a major cause of pelvic inflammatory disease, ectopic pregnancy and infertility, and can also contribute to the transmission of the human immunodeficiency virus (HIV). The appearance of gonococcal resistance to penicillins and tetracyclines has been observed since the 1970s. Last century, and resistance has been widespread since the 1980s. Relatively recently - somewhere in the 1990s. resistance to fluoroquinolones appeared and began to grow rapidly. The first cases of resistance of gonococci to fluoroquinolones (mainly ciprofloxacin) were reported in Asia, then strains of gonococci resistant to fluoroquinolones appeared in the United States in Hawaii, then in other western States. Currently, this problem has become relevant to all regions of the United States, which led to a review in 2007 of the recommendations of the United States Centers for Disease Control and Prevention (CDC) - fluoroquinolones are no longer recommended as drugs for the treatment of gonorrhea. The CDC now recommends combination therapy for the treatment of gonorrhea - administration of ceftriaxone 250 mg once + azithromycin 1 g once or doxycycline 100 mg 2 times daily for 7 days.
Published in the July issue of the official CDC publication Morbidity and Mortality Weekly Report, the dynamics of resistance to cephalosporins from N strains are presented. gonorrhoeae in patients in the United States from 2000 to 2010 using data from the Gonococcal Isolate Surveillance Project (GISP). During the study period, the proportion of isolates with increased minimum inhibitory concentration (MIC) values for cephalosporins (more than 0.25 μg / ml for cefixime and more than 0.125 μg / ml for ceftriaxone ) went from 0.2% in 2000 to 1.4% in 2010 for cefixime and from 0.1% in 2000 to 0.3% in 2010 for ceftriaxone.
Although cephalosporins remain effective antimicrobials for treating gonococcal infections, doctors should clearly monitor treatment failure and report it to national and local health authorities. In addition, particular attention should be paid to the development of patient management protocols for ineffective treatment of cephalosporin gonorrhea, as well as to the reporting of cases of ineffective use of cephalosporin in gonorrhea to the Centers for Disease Control and Prevention in the United States.