Optimizing treatment of antimicrobial-resistant Neisseria gonorrhoeae

被引:21
作者
Roy, K [1 ]
Wang, SA [1 ]
Meltzer, MI [1 ]
机构
[1] Ctr Dis Control & Prevent, Off Workforce & Career Dev, Atlanta, GA 30333 USA
关键词
D O I
10.3201/eid1108.050157
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
The increasing prevalence of ciprofloxacin-resistant Neisseria gonorrhoeae has required replacing inexpensive oral ciprofloxacin treatment with more expensive injectable ceftriaxone. Further, monitoring antimicrobial resistance requires culture testing, but nonculture gonorrhea tests are rapidly replacing culture. Since the strategies were similar in effectiveness (> 99%), we evaluated, from the healthcare system perspective, cost-minimizing strategies for both diagnosis (culture followed by antimicrobial susceptibility tests versus nonculture-based tests) and treatment (ciprofloxacin versus ceftriaxone) of gonorrhea in women. Our results indicate that switching from ciprofloxacin to ceftriaxone is cost-minimizing (i.e., optimal) when the prevalence of gonorrhea is > 3% and prevalence of ciprofloxacin resistance is > 5%. Similarly, culture-based testing and susceptibility surveillance are optimal when the prevalence of gonorrhea is < 13%; nonculture-based testing is optimal (cost-minimizing) when gonorrhea prevalence is >= 13%.
引用
收藏
页码:1265 / 1273
页数:9
相关论文
共 29 条
[1]   THE INCREMENTAL COST OF SCREENING, DIAGNOSIS, AND TREATMENT OF GONORRHEA AND CHLAMYDIA IN A FAMILY-PLANNING CLINIC [J].
BEGLEY, CE ;
MCGILL, L ;
SMITH, PB .
SEXUALLY TRANSMITTED DISEASES, 1989, 16 (02) :63-67
[2]  
*CDCP, 1996, MMWR-MORBID MORTAL W, V45, P883
[3]  
*CDCP, 2002, MMWR MORB MORTAL WKL, V51
[4]  
*CDCP, 2002, SEX TRANSM DIS SURV
[5]  
Centers for Disease Control and Prevention, 2004, MMWR-MORBID MORTAL W, V55, P335
[6]  
Centers for Disease Control and Prevention, 1987, MMWR S, V36, p1S
[7]  
Centers for Disease Control and Prevention (CDC), 2002, MMWR Morb Mortal Wkly Rep, V51, P1041
[8]  
Centers for Disease Control and Prevention (CDC), 2000, MMWR Morb Mortal Wkly Rep, V49, P833
[9]  
Chesson HW, 2000, J ACQ IMMUN DEF SYND, V24, P48
[10]  
Cohen MS, 1998, LANCET, V351, P5, DOI 10.1016/S0140-6736(98)90002-2