Which cephalosporin for gonorrhoea?

Ison, Catherine

doi:10.1136/sti.2004.012757

Cited by 24 publications

(12 citation statements)

References 22 publications

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“…However, other particularly oral cephalosporins have been used in different countries [e.g. cefuroxime, cefpodoxime, ceftibuten, cefditoren and celdinir (12, 16, 38, 96–98)]. During the last two decades, resistance to ESCs in N. gonorrhoeae strains appears to have initially emerged in Japan and subsequently spread worldwide.…”

Section: Antimicrobial Resistance In Neisseria Gonorrhoeaementioning

confidence: 99%

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

2016

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Neisseria gonorrhoeae is a strictly human pathogen that is typically transmitted by sexual contact. The associated disease gonorrhea has plagued humankind for thousands of years, with a current estimated incidence of 78 million cases per year. Advances in antimicrobial discovery in the 1920s and 1930s leading to the discovery of sulfonamides and penicillin begun the era of effective antimicrobial treatment of gonorrhea. Unfortunately, the gonococcus developed decreased susceptibility or even resistance to these initially employed antibiotics, a trend that continued over subsequent decades with each new antibiotic that was brought into clinical practice. As this pattern of resistance has continued into the 21st century, there is now reason for great concern, especially in an era when few new antibiotics have prospects for use as treatment of gonorrhea. Here, we review the history of gonorrhea treatment regimens and gonococcal resistance to antibiotics, the mechanisms of resistance, resistance monitoring schemes that exist in different international settings, global responses to the challenge of resistance, and prospects for future treatment regimens in the 21st century.

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Section: Antimicrobial Resistance In Neisseria Gonorrhoeaementioning

confidence: 99%

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

2016

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“…Oral cephalosporins with activity against N. gonorrhoeae include cefuroxime axetil,69, 70 cefaclor,71 cefixime,72-75 cefpodoxime proxetil,76, 77 ceftibuten,78 cefdinir,79 and cefoperozone (see Table 1). 80, 81 The WHO recommends cefixime 400mg and in the United States, cefixime 400mg is the only oral regimen recommended as first line therapy.…”

Section: Cephalosporins For the Treatment Of Gonococcal Infectionsmentioning

confidence: 99%

“…Cefuroxime 1.5gm IM is occasionally used in the United Kingdom. 70 Cefodizime has also been studied and used in Japan and has shown activity against recent multidrug resistant Japanese isolates 33, 101-103. However, these agents do not provide any advantage over ceftriaxone (See Table 2) and so are not routinely recommended.…”

Section: Cephalosporins For the Treatment Of Gonococcal Infectionsmentioning

confidence: 99%

The use of cephalosporins for gonorrhea: the impending problem of resistance

Barry

Klausner²

2009

Expert Opinion on Pharmacotherapy

149

118

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Gonorrhea remains an important clinical and public health problem throughout the world. Gonococcal infections have historically been diagnosed by Gram stain and culture, but are increasingly diagnosed through nucleic acid tests thereby eliminating the opportunity for antimicrobial susceptibility testing. Gonococcal infections are typically treated with single-dose therapy with an agent found to cure >95% of cases. Unfortunately, the gonococcus has repeatedly developed resistance to antimicrobials including sulfonamides, penicillin, tetracyclines, and fluoroquinolones. This has left third-generation cephalosporins as the lone class of antimicrobials currently recommended as first line therapy for gonorrhea in some regions. However, resistance to oral third-generation cephalosporins has emerged and spread in Asia, Australia and elsewhere. The mechanism of this resistance seems to be associated with a mosaic penicillin binding protein (penA) in addition to other chromosomal mutations previously found to confer resistance to beta-lactam antimicrobials (ponA, mtrR, penB, pilQ). Few good options exist or are in development for treating cephalosporin resistant isolates as most have had multidrug resistance. Preventing the spread of resistant isolates will depend on ambitious antimicrobial management programs, strengthening and expanding surveillance networks, and through effective sexually transmitted disease control and prevention.

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“…No other injectable or oral ESCs have any evident advantages over ceftriaxone and cefixime (17,63,136). Nevertheless, other oral cephalosporins have been used when cefixime has not been available, e.g., cefditoren and celdinir in Japan, cefuroxime in several European countries, cefpodoxime in the United States, and ceftibuten in Hong Kong (63,(136)(137)(138). During the last 2 decades, gonococcal strains exhibiting resistance to ESCs seem to have initially emerged in Japan and then spread worldwide.…”

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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Which cephalosporin for gonorrhoea?

Cited by 24 publications

References 22 publications

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

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

The use of cephalosporins for gonorrhea: the impending problem of resistance

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

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