Global Resistance of Neisseria gonorrhoeae

When Theory Becomes Reality

David A. Lewis


Curr Opin Infect Dis. 2014;27(1):62-67. 

In This Article

Gonococcal Resistance to Extended Spectrum Cephalosporins

With the demise of fluoroquinolones, most countries moved to the use of third-generation ESCs as first-line therapy for gonorrhoea. Many regard ESC as the last antimicrobial agent class suitable for widespread single-dose single-agent therapy. Among the oral ESCs, only cefixime has met the criterion on the lower bound of the 95% confidence interval (CI) for effective treatment of pharyngeal gonorrhoea as defined by the WHO recommended cure rate of 95% or greater.[3]

In 2001, following the widespread use of oral ESCs in Japan, gonococci with reduced susceptibility to these agents emerged in Japan and were associated with cefixime treatment failures.[4–6] It was noted early on that, while these early strains were generally resistant to fluoroquinolones and penicillin, they remained susceptible to intramuscular ceftriaxone, albeit with raised ceftriaxone MICs compared with fully susceptible strains.[4]