In vitro antibiotic susceptibilities of Neisseria gonorrhoeae isolates in the Philippines

Antibiotic susceptibilities were determined for 122 Neisseria gonorrheae isolates obtained from 400 sex workers in Jakarta, Indonesia, and susceptibilities to ciprofloxacin, cefuroxime, cefoxitin, cefotaxime, ceftriaxone, chloramphenicol, and spectinomycin were found. All isolates were resistant to tetracycline. A number of the isolates demonstrated decreased susceptibilities to erythromycin (MIC > 1.0 g/ml), thiamphenicol (MIC > 1.0 g/ml), kanamycin (MIC > 16.0 g/ml), penicillin (MIC > 2.0 g/ml), gentamicin (MIC > 16.0 g/ml), and norfloxacin (MIC ‫؍‬ 0.5 g/ml). These data showed that certain antibiotics previously used in the treatment of gonorrhea are no longer effective.

supporting

confidence: 83%

mentioning

confidence: 99%

In Vitro Antibiotic Susceptibility of Neisseria gonorrhoeae in Jakarta, Indonesia

Lesmana

Lebron

Taslim³

et al. 2001

“…More recently, however, the incidence of gonorrhea has been increasing and was up to 13 reported cases per 100,000 population in 2001 (10). The documentation of a case of gonococcal urethritis with clinical and laboratory failure of ciprofloxacin therapy (9) prompted a study of the antimicrobial susceptibilities of N. gonorrhoeae isolates in the Tel Aviv area of Israel.Gonococcal strains with reduced in vitro susceptibilities to fluoroquinolones (MIC of ciprofloxacin, 0.125 to 0.5 g/ml) were first described in the mid-1980s (5) and since then have been identified in the Far East (7,8,20), Australia (21, 22), Africa (3), Europe (12,13,23), and the United States (4). Fluoroquinolone-resistant N. gonorrhoeae (ciprofloxacin MICs, Ն1 g/ml) emerged during the early 1990s and became well established in several Asian countries (16).…”

mentioning

confidence: 99%

“…Gonococcal strains with reduced in vitro susceptibilities to fluoroquinolones (MIC of ciprofloxacin, 0.125 to 0.5 g/ml) were first described in the mid-1980s (5) and since then have been identified in the Far East (7,8,20), Australia (21,22), Africa (3), Europe (12,13,23), and the United States (4). Fluoroquinolone-resistant N. gonorrhoeae (ciprofloxacin MICs, Ն1 g/ml) emerged during the early 1990s and became well established in several Asian countries (16).…”

mentioning

confidence: 99%

High Prevalence of High-Level Ciprofloxacin Resistance in Neisseria gonorrhoeae in Tel Aviv, Israel: Correlation with Response to Therapy

Dan

Poch

Sheinberg

2002

A survey of the drug susceptibilities of gonococcal isolates from 100 consecutive patients attending clinics in the Tel Aviv area of Israel during the period from February to September 2000 has shown a 61% rate of ciprofloxacin resistance (MICs, >1 g/ml); 51 isolates were highly resistant (MICs, >4 g/ml). Ciprofloxacinresistant strains were more prevalent among isolates with chromosomally mediated resistance to penicillin and tetracycline. Therapeutic failures with ciprofloxacin correlated with MICs of >1 mg/ml (P < 0.01). The high rate of ciprofloxacin resistance coinciding with a sharp rise in the incidence of gonorrhea precludes the use of fluoroquinolone drugs for the empirical treatment of gonococcal infections acquired in Israel.Gonorrhea was rarely reported in Israel in the 1990s, with an average annual incidence of 0.9 cases per 100,000 population (14). As most laboratories did not carry appropriate media, diagnosis was usually made on the basis of Gram-stained smears, and susceptibility testing of Neisseria gonorrhoeae was not routinely performed. More recently, however, the incidence of gonorrhea has been increasing and was up to 13 reported cases per 100,000 population in 2001 (10). The documentation of a case of gonococcal urethritis with clinical and laboratory failure of ciprofloxacin therapy (9) prompted a study of the antimicrobial susceptibilities of N. gonorrhoeae isolates in the Tel Aviv area of Israel.Gonococcal strains with reduced in vitro susceptibilities to fluoroquinolones (MIC of ciprofloxacin, 0.125 to 0.5 g/ml) were first described in the mid-1980s (5) and since then have been identified in the Far East (7,8,20), Australia (21, 22), Africa (3), Europe (12,13,23), and the United States (4). Fluoroquinolone-resistant N. gonorrhoeae (ciprofloxacin MICs, Ն1 g/ml) emerged during the early 1990s and became well established in several Asian countries (16). Strains for which ciprofloxacin MICs were Ն8 g/ml were first isolated in 1994 (15) and have mostly been detected in the Far East (1, 24). Two cases of gonorrhea caused by strains for which the MIC was 16 g/ml were recently reported in the United States (5). These changes in the susceptibility patterns of N. gonorrhoeae may lead to the reassessment of the current recommendations for empirical therapy of gonococcal infection (6). Continuous surveillance of the epidemiology of N. gonorrhoeae based on type characterization and detailed in vitro testing of the antimicrobial susceptibilities of isolates are imperative for establishing empirical treatment guidelines. MATERIALS AND METHODSSource of isolates. N. gonorrhoeae strains were isolated from clinical specimens (mostly urethral discharges from male patients) at the Central Laboratory of Maccabi Health Services, Rishon-le-Zion, Israel. The Central Laboratory serves a population of 400,000 in the Tel Aviv area, situated in central Israel. All isolates recovered from February 2000 and on were transferred to the Infectious Diseases Research Laboratory at the E. Wolfson Hospital, Holon, Israel. ...

“…These concerns are based in large part on reports of high levels of quinolone resistance occurring among patients attending sexually transmitted disease clinics in the Philippines (Sa). Since that time, several published reports from the same area suggest that while clinically significant quinolone resistance is present in that area, the proportion of isolates displaying this form of resistance is relatively low (3,4). There have been few reports of high-level quinolone resistance in North Americans who have not traveled to areas of southeast Asia where quinolone resistance is more common.…”

Section: Discussionmentioning

confidence: 97%

Comparison of ciprofloxacin and ceftriaxone as single-dose therapy for uncomplicated gonorrhea in women

Hook

Jones

Martín

et al. 1993

Although women bear. the brunt of gonococcal infection-related morbidity, few large studies of gonorrhea treatment in women have been conducted. In a multicenter, double-blind, placebo-controlled trial, 181 evaluable women with uncomplicated gonorrhea were treated with ciprofloxacin (250 mg orally; 94 women) or ceftriaxone (250 mg intramuscularly; 87 women). Twenty-four percent of the participants were infected with antibiotic-resistant Neisseria gonorrhoeae. Cervical gonorrhea was cured in 100%o (93 of 93) of the women treated with ciprofloxacin and 99% (83 of 84) receiving ceftriaxone. All pharyngeal (n = 5) or rectal (n = 20) infections treated with ciprofloxacin were cured, as were ceftriaxone-treated patients with pharyngeal (n = 6) or rectal (n = 21) infection. Geometric mean MICs (range) for 248 pretreatment isolates were: penicillin, 0.28 (0.015 to 8.0); tetracycline, 0.46 (0.06 to 4); ciprofloxacin, 0.003 (0.002 to 0.015); and ceftriaxone, 0.004 (0.001 to 0.125) ,ug/ml. Both drugs were well tolerated. Despite the high prevalence of antibiotic-resistant gonococci in these populations, 250 mg of oral ciprofloxacin was as effective as an injection of ceftriaxone.Despite the more than 30% decline in gonorrhea cases reported in the decade of the 1980s, infections due to Neisseria gonorrhoeae continue to be the most common reportable bacterial disease in the United States (5). The proportion of isolates resistant to penicillin or tetracycline also has increased dramatically.Although not yet a major problem in the United States, development of resistance to alternative therapies such as spectinomycin or even the newer quinolones is a continuing concern (1, 5, 15). In addition, gonorrhea rates tend to be highest in Americans aged 15 to 24 years, but late consequences which disproportionately affect women (e.g., infertility, ectopic pregnancy) often do not become apparent until years after the acute infection. Paradoxically, while gonorrhea and its sequelae tend to most profoundly affect females, studies of gonorrhea therapy predominantly report data for men. To provide more data on the treatment of gonorrhea in women and on the utility of ciprGfloxacin, a currently recommended alternative to ceftriaxone for gonorrhea treatment, we conducted a prospective, multicenter, randomized, double-blind, placebo-controlled trial comparing 250 mg of oral ciprofloxacin with 250 mg of intramuscular ceftriaxone for therapy of uncomplicated gonorrhea in women attending sexually transmitted disease (STD) clinics. MATERIALS AND METHODSStudy design. The study was a prospectively conducted, randomized, double-blind, placebo-controlled trial in which all participants received both an injection and a single oral dose of medication. All medications were administered by a third party who had been instructed not to inform the study * Corresponding author.clinician of the therapeutic regimen utilized. Patients randomized to ciprofloxacin therapy received one 250-mg tablet of ciprofloxacin orally and an injection of sterile 0.9% sodium c...