Single dose 1 g ceftriaxone for urogenital and pharyngeal infection caused by Neisseria gonorrhoeae

Abstract

Objectives:To evaluate the efficacy of 1 g ceftriaxone in the treatment of urethritis, cervicitis and pharyngeal infection caused by Neisseria gonorrhoeae (N. gonorrhoeae) including the oral cephem-resistant strain with chimera penicillin-binding protein 2 (PBP-2) (cefozopran-resistant N. gonorrhoeae, CZRNG). Methods: From September 2004 to November 2006, 67 patients (27 male and 40 female) who had genital infection and/or pharyngeal infection caused by N. gonorrhoeae were enrolled in this study at five participating centers in Japan. To detect the chimera PBP-2 gene, polymerase chain reaction (PCR) was performed using established primers against the altered penA of CZRNG isolates. All patients received a single 1 g dose of ceftriaxone. Efficacy was evaluated only in those who returned for examination and culture for N. gonorrhoeae between 3 and 14 days after the treatment. Results: CZRNG isolates detected by PCR accounted for 41.7% (20/48) of urogenital infections and 60.0% (15/25) of pharyngeal infections in the treatment efficacy evaluable cases. 37 of 39 CZRNG isolates (94.9%) were multi-drug resistant isolates that had simultaneous resistance to penicillin, tetracycline, and ciprofloxacin. Nineteen patients had N. gonorrhoeae isolates in the urogenital area and pharynx simultaneously. Ceftriaxone treatment eradicated all N. gonorrhoeae isolates from 48 patients with genitourinary infection and 25 patients with pharyngeal infection. Conclusions: We report for the first time that ceftriaxone is effective in patients with gonococcal urethritis, cervicitis, and pharyngeal infection caused by CZRNG that has chimera PBP-2.

Should urologists care for the pharyngeal infection of Neisseria gonorrhoeae or Chlamydia trachomatis when we treat male urethritis?

“…The prevalence of pharyngeal infection is depended on the method for detection, such as culturing or nucleic acid amplification tests, the kinds of specimens, such as pharyngeal swabs or oral wash specimens, and the timing of taking the specimens. Detection rates by nucleic acid amplification tests probably appeared higher than those from culturing to detect N. gonorrhoeae [6][7][8]. In addition, the detection rates of C. trachomatis in oral wash specimens were higher than those in swab specimens [5].…”

“…However, we could not find enough evidence in the literature. In Japan, only two papers [7,8] regarding pharyngeal infection of N. gonorrhoeae were found. In these papers, a single 1-g dose ceftriaxone could eradicate N. gonorrhoeae at the pharynx, but a single 1-g dose cefodizime could not.…”

“…In heterosexual men, the detection rates of N. gonorrhoeae or C. trachomatis at the pharynx were 30% (18/61) or 10% (6/60), respectively, when N. gonorrhoeae or C. trachomatis was detected in the genital specimens. For the treatment of these pathogens at the pharynx, only 2 papers [7,8] regarding N. gonorrhoeae were found. A single 1-g dose of ceftriaxone could eradicate N. gonorrhoeae at both the pharyngeal sites and genital sites, but a single 1-g dose of cefodizime could not eradicate all N. gonorrhoeae at the pharyngeal sites.…”

Gonococcal Resistance: Are Cephalosporins Next?

“…Alternatives that have been proposed include ceftriaxone in higher doses administered intramuscularly or intravenously, azithromycin, spectinomycin, gentamicin, and combination therapy with more than one antimicrobial. Ceftriaxone, 1 g intravenously, was found to eradicate urogenital and pharyngeal N. gonorrhoeae, including isolates resistant to the oral cephalosporin cefozopran [52], and is now recommended for treatment of gonorrhea in Japan [53]. However, intravenous administration of therapy is expensive, administratively difficult, and may be associated with adverse effects related to medication administration.…”

Current and future treatment options for gonorrhoea

“…Increased doses of ceftriaxone have been used for a number of years in many settings globally 12 13 22 24–27. In some countries, such as Japan, China, Azerbaijan and Belarus, ceftriaxone 1 g×1 has been recommended,24 – 27 and it is probable that a dosage of up to 2 g×1 would be safe, based on those used for treatment of community-acquired pneumonia. Accordingly, increased dosages of 500 mg to 1 g have been recommended by some guidelines, giving the bacteria a greater hurdle to jump, but even so this will only provide a short-term solution.…”