Drug resistance has eliminated another antimicrobial agent from the clinical arsenal against gonorrhea. The US Centers for Disease Control and Prevention (CDC) announced today that it no longer recommends the oral cephalosporin cefixime at any dose as a first-line treatment for Neisseria gonorrhoeae infections.
The recommendation is based on data from the CDC’s Gonococcal Isolate Surveillance Project showing that the standard 400-mg oral dose of cefixime no longer inhibits N gonorrhoeae growth sufficiently enough to cure gonorrhea. From 2006 to 2011, the percentage of treatment-resistant N gonorrhoeae samples taken from men at participating clinics increased from 0.1% to 1.5%. Cities with the largest increases were Honolulu (0% to 17%); Minneapolis (0% to 6.9%); Portland, Ore (0% to 6.5%); and San Diego (0% to 6.4%). The data also show that treatment-resistant gonorrhea was more common among men who have sex with men than among men who have sex only with women.
By curtailing cefixime use for gonorrhea, the CDC said it hopes to spare another cephalosporin, ceftriaxone, from becoming drug resistant. “Continued use of cefixime might hasten the development of resistance to ceftriaxone, a safe, well-tolerated, injectable cephalosporin and the last antimicrobial that is recommended and known to be highly effective in a single dose for treatment of gonorrhea at all anatomic sites of infection,” the agency writes in the August 10 issue of its Morbidity and Mortality Weekly Report.
The CDC now recommends combination therapy for uncomplicated gonorrhea: a single 250-mg intramuscular dose of ceftriaxone plus either a single 1-g oral dose of azithromycin or 100 mg orally of doxycycline twice daily for 7 days.
Gonorrhea is the second most commonly reported notifiable infectious disease in the United States. The CDC estimates that more than 300 000 cases were reported in 2011. The disease causes pelvic inflammatory disease, ectopic pregnancy, and infertility and also facilitates HIV transmission.
In 2007, drug resistance rendered the fluoroquinolone class of antimicrobials ineffective against gonorrhea. “Resistance to cephalosporins, including ceftriaxone, is expected to emerge,” the CDC writes. “New treatment options for gonorrhea are urgently needed.”