Efficacy and safety of ceftriaxone for uncomplicated gonorrhoea: a meta-analysis of randomized controlled trials

Bai, ZG; Bao, XJ; Wd, Cheng; Yang, Kai-Cheng; Yp, Li

doi:10.1258/ijsa.2009.009198

Cited by 14 publications

(14 citation statements)

References 20 publications

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“…[34] Although the majority of the circulating gonococcal isolates in the US have a ceftriaxone MIC <0.03 µg/mL, there are no randomized controlled trials (RCT) comparing the efficacy of varying doses of ceftriaxone in contemporary times. A recent meta-analysis reviewed RCTs which compare ceftriaxone to other antimicrobials,[35] concluded that 250mg of intramuscular ceftriaxone is superior to 400mg oral cefixime, 2g intramuscular spectinomycin and 500mg of cefotaxime.…”

Section: Evidence For Current Recommended Treatment Regimensmentioning

confidence: 99%

Preparing for an era of untreatable gonorrhea

Barbee

2014

Current Opinion in Infectious Diseases

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Purpose of Review The proportion of Neisseria gonorrhoeae isolates with reduced susceptibility to extended-spectrum cephalosporins (ESC) has increased rapidly since 2006. Clinicians, researchers and public health officials need to be prepared for the possibility of an era of untreatable gonorrhea. This review focuses on the evidence for current gonorrhea treatment recommendations, potential future treatment options, and other methods to control gonorrhea. Recent Findings In addition to an increased in isolates with decreased susceptibility to ESCs, there have been reported treatment failure to both cefixime and ceftriaxone. In response, some countries have increased the recommended cephalosporin dose, and most now recommend dual-therapy with an ESC and azithromycin. The pharynx has been implicated as a site for acquiring resistance through transformation with commensal Neisseria species or induced resistance through subtherapeutic antimicrobial levels. Thus, appropriate screening of the pharynx and treatment with a regimen which eradicates gonorrhea from the pharynx is necessary. At present, several studies are evaluating various novel treatment regimens in preparation for an era of untreatable gonorrhea. Summary Screening for asymptomatic infections, maintaining culture capacity to monitor antimicrobial resistance, treating with ceftriaxone plus azithromycin, and ensuring that all sexual partners are treated, are among the best strategies to control gonorrhea in the current clime.

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Section: Evidence For Current Recommended Treatment Regimensmentioning

confidence: 99%

Preparing for an era of untreatable gonorrhea

Barbee

2014

Current Opinion in Infectious Diseases

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“…cefixime 800 mg × 1 plus azithromycin 1 g × 1. Mainly early evidence indicated that cefixime 800 mg × 1 was safe and effective in treating gonorrhoea [ 66 , 69 , 71 , 72 , 75 , 76 ]. Pharmacodynamic studies and/or simulations have also shown that, compared to 400 mg × 1, 800 mg of cefixime (particularly administered as 400 mg × 2, 6 hours apart) substantially increases the f T >MIC of cefixime [ 22 , 52 ].…”

Section: Reviewmentioning

confidence: 99%

Current and future antimicrobial treatment of gonorrhoea – the rapidly evolving Neisseria gonorrhoeae continues to challenge

2015

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Neisseria gonorrhoeae has developed antimicrobial resistance (AMR) to all drugs previously and currently recommended for empirical monotherapy of gonorrhoea. In vitro resistance, including high-level, to the last option ceftriaxone and sporadic failures to treat pharyngeal gonorrhoea with ceftriaxone have emerged. In response, empirical dual antimicrobial therapy (ceftriaxone 250–1000 mg plus azithromycin 1–2 g) has been introduced in several particularly high-income regions or countries. These treatment regimens appear currently effective and should be considered in all settings where local quality assured AMR data do not support other therapeutic options. However, the dual antimicrobial regimens, implemented in limited geographic regions, will not entirely prevent resistance emergence and, unfortunately, most likely it is only a matter of when, and not if, treatment failures with also these dual antimicrobial regimens will emerge. Accordingly, novel affordable antimicrobials for monotherapy or at least inclusion in new dual treatment regimens, which might need to be considered for all newly developed antimicrobials, are essential. Several of the recently developed antimicrobials deserve increased attention for potential future treatment of gonorrhoea. In vitro activity studies examining collections of geographically, temporally and genetically diverse gonococcal isolates, including multidrug-resistant strains particularly with resistance to ceftriaxone and azithromycin, are important. Furthermore, understanding of effects and biological fitness of current and emerging (in vitro induced/selected and in vivo emerged) genetic resistance mechanisms for these antimicrobials, prediction of resistance emergence, time-kill curve analysis to evaluate antibacterial activity, appropriate mice experiments, and correlates between genetic and phenotypic laboratory parameters, and clinical treatment outcomes, would also be valuable. Subsequently, appropriately designed, randomized controlled clinical trials evaluating efficacy, ideal dose, toxicity, adverse effects, cost, and pharmacokinetic/pharmacodynamics data for anogenital and, importantly, also pharyngeal gonorrhoea, i.e. because treatment failures initially emerge at this anatomical site. Finally, in the future treatment at first health care visit will ideally be individually-tailored, i.e. by novel rapid phenotypic AMR tests and/or genetic point of care AMR tests, including detection of gonococci, which will improve the management and public health control of gonorrhoea and AMR. Nevertheless, now is certainly the right time to readdress the challenges of developing a gonococcal vaccine.

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“…Treatment for cure of CT and NG is effective (> 95% for CT and > 85% for NG, if uncomplicated infection) if properly adhered to, and will reduce the risk for complications of the infections as described above. Antibiotics typically used to treat CT and NG (described in Additional file 2) are quite commonly (15-25%) associated with mild adverse effects (AEs) including diarrhea, vomiting, constipation, abdominal pain, vertigo, fatigue and headache [44, 45]. The majority of AEs from CT and NG treatment are gastrointestinal in nature and may be severe in some cases particularly for NG where combination treatment or higher-dose single agents are used (e.g., 2 vs. 1 g dose of azithromycin).…”

Section: Introductionmentioning

confidence: 99%

“…The majority of AEs from CT and NG treatment are gastrointestinal in nature and may be severe in some cases particularly for NG where combination treatment or higher-dose single agents are used (e.g., 2 vs. 1 g dose of azithromycin). Very rarely (< 1 in 1000 people treated), people will have serious adverse drug reactions leading to hospitalization, from severe allergy to the antibiotic, Clostridium difficile colitis (possibly with life-threatening diarrhea), liver toxicity, heartbeat irregularities (from azithromycin although mainly for multi-day doses in specific patient subgroups), or other organ complications [44–48].…”

Section: Introductionmentioning

confidence: 99%

Screening for chlamydia and/or gonorrhea in primary health care: protocol for systematic review

et al. 2018

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BackgroundChlamydia trachomatis and Neisseria gonorrhoeae are the most commonly reported sexually transmitted infections in Canada. Existing national guidance on screening for these infections was not based on a systematic review, and recommendations as well as implementation considerations (e.g., population groups, testing and case management) should be explicit and reflect the quality of evidence. The aim of this systematic review is to synthesize research on screening for these infections in sexually active individuals within primary care. We will also review evidence on how people weigh the relative importance of the potential outcomes from screening, rated as most important by the Canadian Task Force on Preventive Health Care (CTFPHC) with input from patients and stakeholders.MethodsWe have developed a peer-reviewed strategy to comprehensively search MEDLINE, Embase, Cochrane Library, CINAHL, and PsycINFO for English and French literature published 1996 onwards. We will also search trial registries and conference proceedings, and mine references lists. Screening, study selection, risk of bias assessments, and quality of findings across studies (for each outcome) will be independently undertaken by two reviewers with consensus for final decisions. Data extraction will be conducted by one reviewer and checked by another for accuracy and completeness. The CTFPHC and content experts will provide input for decisions on study design (i.e., when and whether to include uncontrolled studies for screening effectiveness) and for interpretation of the findings.DiscussionThe results section of the review will include a description of all studies, results of all analyses, including planned subgroup and sensitivity analyses, and evidence profiles and summary of findings tables incorporating assessment based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods to communicate our confidence in the estimates of effect. We will compare our findings to others and discuss limitations of the review and available literature. The findings will be used by the CTFPHC—supplemented by consultations with patients and stakeholders and from other sources on issues of feasibility, acceptability, costs/resources, and equity―to inform recommendations on screening to support primary health care providers in delivering preventive care.Systematic review registrationInternational Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018100733.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0904-5) contains supplementary material, which is available to authorized users.

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Efficacy and safety of ceftriaxone for uncomplicated gonorrhoea: a meta-analysis of randomized controlled trials

Cited by 14 publications

References 20 publications

Preparing for an era of untreatable gonorrhea

Preparing for an era of untreatable gonorrhea

Current and future antimicrobial treatment of gonorrhoea – the rapidly evolving Neisseria gonorrhoeae continues to challenge

Screening for chlamydia and/or gonorrhea in primary health care: protocol for systematic review

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