National Gonorrhea Therapy Monitoring Study

Abstract

To monitor temporal trends and regional differences in antibiotic susceptibility, we measured the minimum inhibitory concentrations for penicillin G, ampicillin, tetracycline, and spectinomycin of 4405 pre-treatment gonococcal isolates from patients with uncomplicated gonorrhea. As compared to isolates studied in 1970-1971, recent United States isolates appeared equally sensitive to penicillin G and more sensitive to tetracycline. Relatively resistant strains were found throughout the country. We also studied 1974 patients, treated for uncomplicated gonorrhea according to the 1972 regimens recommended by the United States Public Health Service, to determine the relation between pretreatment minimum inhibitory concentrations and treatment results. For patients receiving the procaine penicillin-probenecid and ampicillin-probenecid regimens, minimum inhibitory concentrations to the treatment drugs were significantly higher in patients not cured than in those cured (P less than 0.01 fr penicillin and P less than 0.05 for ampicillin). In contrast, spectinomycin-treatment results appeared to be independent of the isolate's susceptibility to spectinomycin and other antibiotics.

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

“…Penicillin cured more than 95% of cases, with total doses as low as 45 mg being used (85). However, over time, the MICs of penicillin against gonococcal strains increased due to an accumulation of chromosomal resistance determinants, and the prescribed doses were progressively increased to obtain appropriate cure rates (8,63,(86)(87)(88)(89). Thus, by 1946, four gonorrhea cases resistant to "high" doses of penicillin (0.6 to 1.6 million units) were reported, and this resistance was also verified by in vitro testing.…”

Antimicrobial Resistance Expressed by Neisseria gonorrhoeae : A Major Global Public Health Problem in the 21st Century

“…Penicillin rapidly became the recommended first-line treatment for gonorrhea (36, 37). However, during the following decades the penicillin MICs in gonococcal strains increased, due to emergence of chromosomal AMR determinants, and the recommended doses had to be progressively increased for cure (12, 16, 38, 39–44). The emergence and subsequent international spread of two types of β-lactamase-encoding plasmids, originating in South-East Asia and Sub-Saharan West Africa, in certain gonococcal strains from the USA and United Kingdom (UK) in 1976, which caused high-level resistance to penicillin (23, 24), reinforced the fear that the effectiveness of penicillin might soon end.…”

“…Furthermore, N. gonorrhoeae strains with high-level azithromycin resistance (MIC≥256 μg/ml) have been reported from an increasing number of countries, including Scotland (82), UK (37), Ireland (84), Italy (85), Sweden (86), China (88), Australia (87), Argentina (38), Canada (91), and the USA (39). It is also of grave concern that the first global gonorrhea treatment failure using dual antimicrobial therapy (ceftriaxone 500 mg×1 and azithromycin 1 g×1) was recently verified.…”

In vitro Susceptibility of β-Lactamase Positive and β-Lactamase Negative Strains of Neisseria gonorrhææ to Cefuroxime

“…Susceptibility tests were performed by an agar dilution technique with a Steers replicating device, as previously described (Jaffe et al 1976). The inoculum was prepared by removing some overnight growth from a supplemented GC agar plate (see ,B-lactamase tests), suspending it in Mueller-Hinton broth (BBL) and adjusting the turbidity to contain approximately 108 colony forming units (CFU)/ml by comparison with a 0.5 McFarland BaSO4 standard (Bauer et al 1966) or to approximately 107 CFU/ml by measurement in a light scattering device (Thornsberry et al.…”