Implications of current recommendations for third-generation cephalosporin use in the WHO Western Pacific Region following the emergence of multiresistant gonococci

被引:48
作者
Tapsall, J. W. [1 ]
机构
[1] Prince Wales Hosp, Dept Microbiol, Collaborating Ctr STD, WHO, Randwick, NSW 2031, Australia
关键词
NEISSERIA-GONORRHOEAE; ANTIMICROBIAL RESISTANCE; SUSCEPTIBILITY; CEFTRIAXONE; INFECTION; CEFIXIME;
D O I
10.1136/sti.2008.035337
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
To ascertain recommendations for the treatment of gonorrhoea in the WHO Western Pacific Region (WPR) following the emergence of "cephalosporin-resistant'' Neisseria gonorrhoeae and to relate these to clinical and laboratory measures directed towards disease and antibiotic resistance control. WHO WPR Gonococcal Antimicrobial Resistance Programme members provided data on the type, dose and source of third-generation cephalosporins recommended for the treatment of gonorrhoea. Ceftriaxone was recommended more widely (11/15 respondents) than cefixime ( five centres). No cephalosporins were recommended in three jurisdictions. One other oral ( ceftibuten) and injectable ( cefodizime) agent was recommended. Uniform (400 mg) doses of cefixime were recommended but ceftriaxone regimens ranged between 125 mg and 1 g, with nine of 11 respondents using a 250 mg dose. Both generic and proprietary preparations were widely used. Third-generation cephalosporins are widely recommended for the treatment of gonorrhoea in the WPR, with injectable ceftriaxone more extensively so than oral cefixime and in an expanded dose range. Few other cephalosporins were recommended. Current knowledge suggests that the trend towards ceftriaxone treatment in higher doses may decrease the impact of the circulation of "cephalosporin-resistant'' gonococci in the WPR. These recommendations represent public sector practice only and of themselves are unlikely to contain the further spread of "cephalosporin-resistant'' gonococci because of the general clinical use of cephalosporins. Optimisation of strategies for laboratory detection of third-generation cephalosporin resistance can be simplified in the WPR because of the restricted spectrum of cephalosporins recommended. Additional efforts are urgently required for both disease and antibiotic resistance control in gonorrhoea.
引用
收藏
页码:256 / 258
页数:3
相关论文
共 10 条
[1]   Lack of nationwide surveillance of antimicrobial resistance of Neisseria gonorrhoeae in Japan [J].
Deguchi, Takashi ;
Yasuda, Mitsuru ;
Maeda, Shin-ichi .
ANNALS OF INTERNAL MEDICINE, 2008, 149 (05) :363-364
[2]   Neisseria gonorrhoeae isolates with reduced susceptibility to cefixime and ceftriaxone:: Association with genetic polymorphisms in penA, mtrR, porB1b, and ponA [J].
Lindberg, Robert ;
Fredlund, Hans ;
Nicholas, Robert ;
Unemo, Magnus .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2007, 51 (06) :2117-2122
[3]   Ceftibuten resistance and treatment failure of Neisseria gonorrhoeae infection [J].
Lo, Janice Y. C. ;
Ho, K. M. ;
Leung, Anna O. C. ;
Tiu, Felisa S. T. ;
Tsang, Grand K. L. ;
Lo, Angus C. T. ;
Tapsall, John W. .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2008, 52 (10) :3564-3567
[4]   Single dose 1 g ceftriaxone for urogenital and pharyngeal infection caused by Neisseria gonorrhoeae [J].
Muratani, Tetsuro ;
Inatomi, Hisato ;
Ando, Yukiko ;
Kawai, Shuichi ;
Akasaka, Soichiro ;
Matsumoto, Tetsuro .
INTERNATIONAL JOURNAL OF UROLOGY, 2008, 15 (09) :837-842
[5]  
NICHOLAS RA, 2008, P 16 INT PATH NEISS
[6]  
Tapsall John, 2006, Expert Rev Anti Infect Ther, V4, P619, DOI 10.1586/14787210.4.4.619
[7]  
TAPSALL JW, 2008, P 16 INT PATH NEISS
[8]   Molecular Epidemiological Identification of Neisseria gonorrhoeae Clonal Clusters with Distinct Susceptibility Profiles Associated with Specific Groups at High Risk of Contracting Human Immunodeficiency Virus and Syphilis [J].
Wong, Wing-Wai ;
Huang, Chung-Ter ;
Li, Lan-Hui ;
Chiang, Chien-Chou ;
Chen, Bor-Dong ;
Li, Shu-Ying .
JOURNAL OF CLINICAL MICROBIOLOGY, 2008, 46 (12) :3931-3934
[9]   Emerging antimicrobial resistance in Neisseria gonorrhoeae:: Urgent need to strengthen prevention strategies [J].
Workowski, Kimberly A. ;
Berman, Stuart M. ;
Douglas, John M. .
ANNALS OF INTERNAL MEDICINE, 2008, 148 (08) :606-613
[10]  
Yokoi S, 2007, EMERG INFECT DIS, V13, P1275