Antimicrobial Drug Prescription and Neisseria Gonorrhoeae Susceptibility

United States, 2005-2013

Robert D. Kirkcaldy; Monina G. Bartoces; Olusegun O. Soge; Stefan Riedel; Grace Kubin; Carlos Del Rio; John R. Papp; Edward W. Hook III; Lauri A. Hicks


Emerging Infectious Diseases. 2017;23(10):1657-1663. 

In This Article

Abstract and Introduction


We investigated whether outpatient antimicrobial drug prescribing is associated with Neisseria gonorrhoeae antimicrobial drug susceptibility in the United States. Using susceptibility data from the Gonococcal Isolate Surveillance Project during 2005–2013 and QuintilesIMS data on outpatient cephalosporin, macrolide, and fluoroquinolone prescribing, we constructed multivariable linear mixed models for each antimicrobial agent with 1-year lagged annual prescribing per 1,000 persons as the exposure and geometric mean MIC as the outcome of interest. Multivariable models did not demonstrate associations between antimicrobial drug prescribing and N. gonorrhoeae susceptibility for any of the studied antimicrobial drugs during 2005–2013. Elucidation of epidemiologic factors contributing to resistance, including further investigation of the potential role of antimicrobial drug use, is needed.


Neisseria gonorrhoeae, the causative pathogen of gonorrhea, has been designated an urgent antimicrobial drug resistance threat by the Centers for Disease Control and Prevention (CDC).[1] Since the introduction of antimicrobial drugs in the first half of the 20th century, N. gonorrhoeae has successively developed resistance to each antimicrobial agent recommended for gonorrhea treatment.[2] In the United States, the prevalence of resistance in N. gonorrhoeae often varies by sex of partner and by geographic region.[3,4] Prevalence is often greater in isolates from gay, bisexual, and other men who have sex with men (MSM) than those from men who have sex only with women (MSW), and prevalence is often highest in the West and lowest in the South.[4] Resistant strains, in particular penicillinase-producing N. gonorrhoeae (PPNG), fluoroquinolone-resistant N. gonorrhoeae, and gonococcal strains with reduced cephalosporin susceptibility, seemed to emerge initially in the West (Hawaii and the West Coast) before spreading eastward across the country.[5–9] These geographic patterns seem to support the idea that importation of resistant strains from other regions of the world, such as eastern Asia, is a primary factor of the emergence of resistant gonococci in the United States.[5–9] Whereas antimicrobial drug prescribing patterns have been clearly associated with the emergence of resistance in other bacterial pathogens, the degree to which domestic antimicrobial use and subsequent selection pressure contributes to the emergence of gonococcal antimicrobial resistance in the United States is unclear.[10–13] Using an ecologic approach, we sought to investigate the potential geographic and temporal association between antimicrobial drug susceptibility among US N. gonorrhoeae isolates and domestic outpatient antimicrobial drug prescribing rates in the United States during 2005–2013.