Physicians Often Use Inappropriate Antibiotics for Gonorrhea

Marcia Frellick

April 26, 2018

New data show that 18.7% of patients with gonorrhea are not receiving the treatment regimen recommended by the Centers for Disease Control and Prevention (CDC).

Lack of proper treatment is especially concerning in light of the disease's growing resistance to most antibiotics used to treat it, researchers emphasize in an article published online today in the Morbidity and Mortality Weekly Report.

The authors note that gonorrhea is the second most common notifiable disease behind chlamydia, with 468,514 cases reported to state and local health departments in 2016. The case numbers indicate an 18.5% increase from 2015.

Recommended Treatment

As of 2015, the CDC recommends two antibiotics (250 mg ceftriaxone [intramuscular] plus 1 g azithromycin [by mouth]) for treatment of uncomplicated gonorrhea to ensure effective treatment and potentially slow resistance.

However, Emily J. Weston, MPH, from the CDC's Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Atlanta, Georgia, and colleagues found that only 81.3% of patients received the recommended regimen.

Among those who did not receive the recommended treatment, the most frequent prescriptions were "ceftriaxone 250 mg only (5.9%), ceftriaxone any dosage and doxycycline (4.4%), and azithromycin only (3.1%)."

Researchers found no differences in the percentage of patients who received the recommended regimen by race or ethnicity or age of patient, but place of diagnosis showed a disparity.

However, the researchers did find that patients who were diagnosed in a sexually transmitted disease (STD), family planning, or reproductive health center were more likely to receive the regimen than were those diagnosed in other settings (90.8% vs 79.8%; prevalence ratio, 1.14; 95% confidence interval, 1.08-1.20).

Men who have sex with men (MSM) were more likely to receive the recommended regimen across all settings, and they were more likely than non-MSM to be diagnosed in STD clinics.

Several factors may influence whether providers adhere to the recommended regimen, including whether injectable medications are available and whether patients report certain allergies.

The authors also speculate that in settings where providers see fewer gonorrhea cases, they may not be as aware of current recommendations.

"Local and state health departments should monitor adherence with recommendations in their jurisdictions and consider implementing interventions to improve provider and patient compliance," the authors write.

The researchers assessed compliance with the CDC recommendations by checking a random sample in seven jurisdictions participating in the STD Surveillance Network.

Morb Mortal Wkly Rep. Published online April 27, 2018. Full text

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