Multicenter Trial of Single-Dose Azithromycin vs. Ceftriaxone in the Treatment of Uncomplicated Gonorrhea

Hh, Handsfield; Za, Dalu; Dh, Martin; Jm, Douglas; Jm, McCarty; Schlossberg, Daniel

doi:10.1097/00007435-199403000-00010

Cited by 140 publications

(71 citation statements)

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“…Despite being used in several countries, azithromycin is not recommended for empirical monotherapy of gonorrhea. This is due particularly to the concerns of a rapid selection of resistance but also to the possible adverse events from taking the 2-g azithromycin oral dose (37, 134,135). Nevertheless, azithromycin is one of the two antimicrobials in all the introduced dual-antimicrobial therapeutic regimens for gonorrhea (15)(16)(17).…”

Section: Figmentioning

confidence: 99%

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

2014

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SUMMARY Neisseria gonorrhoeae is evolving into a superbug with resistance to previously and currently recommended antimicrobials for treatment of gonorrhea, which is a major public health concern globally. Given the global nature of gonorrhea, the high rate of usage of antimicrobials, suboptimal control and monitoring of antimicrobial resistance (AMR) and treatment failures, slow update of treatment guidelines in most geographical settings, and the extraordinary capacity of the gonococci to develop and retain AMR, it is likely that the global problem of gonococcal AMR will worsen in the foreseeable future and that the severe complications of gonorrhea will emerge as a silent epidemic. By understanding the evolution, emergence, and spread of AMR in N. gonorrhoeae , including its molecular and phenotypic mechanisms, resistance to antimicrobials used clinically can be anticipated, future methods for genetic testing for AMR might permit region-specific and tailor-made antimicrobial therapy, and the design of novel antimicrobials to circumvent the resistance problems can be undertaken more rationally. This review focuses on the history and evolution of gonorrhea treatment regimens and emerging resistance to them, on genetic and phenotypic determinants of gonococcal resistance to previously and currently recommended antimicrobials, including biological costs or benefits; and on crucial actions and future advances necessary to detect and treat resistant gonococcal strains and, ultimately, retain gonorrhea as a treatable infection.

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Section: Figmentioning

confidence: 99%

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

2014

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“…59 Despite concerns about drug resistance, 60 a 2-g dose of azithromycin has resulted in cure rates of 97.7% (95% CI, 94.0%-99.4%) of syphilis cases in a study in Tanzania. 61 A single 2-g dose of azithromycin was 98.9% (95% CI, 97.9%-100%) efficacious against N gonorrhoeae in the United States, 62 while meta-analysis showed that 1 g cures 96.5% (95% CI, 95.3%-97.7%) of C trachomatis infections. 63 A trial in Malawi using 1 g of azithromycinadministeredtwicewithSPIPTp reduced the risk of T vaginalis 35% (P=.02).…”

Section: Commentmentioning

confidence: 99%

Prevalence of Malaria and Sexually Transmitted and Reproductive Tract Infections in Pregnancy in Sub-Saharan Africa

Chico¹,

Mayaud²,

Ariti³

et al. 2012

JAMA

174

129

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“…However, resistance to azithromycin may ultimately limit its utility. Azithromycin is a macrolide antibiotic with a long tissue half-life that has already been shown to be effective against chlamydial urethritis and cervicitis (284), uncomplicated gonorrhea (285), and chancroid (286). Promising results on the use of azithromycin in lieu of BPG for treatment of early venereal syphilis were reported from several studies throughout the 1990s (287)(288)(289) and from large-scale studies performed in Tanzania (290) and Uganda (291), as well as an equivalence trial that involved multiple clinical sites in North America and Madagascar (292).…”

Section: Favorable Conditions and Challenges For Yaws Eradicationmentioning

confidence: 99%

The Endemic Treponematoses

2014

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SUMMARY The agents of human treponematoses include four closely related members of the genus Treponema : three subspecies of Treponema pallidum plus Treponema carateum . T. pallidum subsp. pallidum causes venereal syphilis, while T. pallidum subsp. pertenue , T. pallidum subsp. endemicum , and T. carateum are the agents of the endemic treponematoses yaws, bejel (or endemic syphilis), and pinta, respectively. All human treponematoses share remarkable similarities in pathogenesis and clinical manifestations, consistent with the high genetic and antigenic relatedness of their etiological agents. Distinctive features have been identified in terms of age of acquisition, most common mode of transmission, and capacity for invasion of the central nervous system and fetus, although the accuracy of these purported differences is debated among investigators and no biological basis for these differences has been identified to date. In 2012, the World Health Organization (WHO) officially set a goal for yaws eradication by 2020. This challenging but potentially feasible endeavor is favored by the adoption of oral azithromycin for mass treatment and the currently focused distribution of yaws and endemic treponematoses and has revived global interest in these fascinating diseases and their causative agents.

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Multicenter Trial of Single-Dose Azithromycin vs. Ceftriaxone in the Treatment of Uncomplicated Gonorrhea

Cited by 140 publications

References 0 publications

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

Prevalence of Malaria and Sexually Transmitted and Reproductive Tract Infections in Pregnancy in Sub-Saharan Africa

The Endemic Treponematoses

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