Antibiotic Susceptibility of Neisseria gonorrhoeae

Richard T. Ellison III, MD reviewing Kirkcaldy RD et al. JAMA 2015 Nov 3.

Although national surveillance data suggest that the rise in cephalosporin resistance in N. gonorrhoeae has peaked, the improvements in susceptibility may be short-lived.

Increasing antibiotic resistance in Neisseria gonorrhoeae has led to CDC surveillance for resistance in this pathogen. The finding of decreasing cephalosporin susceptibility caused the CDC in 2010 to recommend combination therapy with either cefixime or high-dose ceftriaxone plus a second antimicrobial agent, and in 2012 to suggest ceftriaxone plus a second antimicrobial agent as the only recommended treatment. Based on data from the Gonococcal Isolate Surveillance Project (GISP), the CDC has now updated its information on gonococcal cephalosporin susceptibility.

Between 2006 and 2014, participating centers in 34 U.S. cities tested 51,144 gonococcal isolates. During this period, the proportion of patients treated with intramuscular ceftriaxone increased from 8.7% to 96.6%. The proportion of isolates resistant to cefixime increased from 0.1% in 2006 to 1.4% in 2011, then declined to 0.4% in 2013 and 0.8% in 2014. Such resistance was more common in men who had sex with men than in those who had sex with women. The proportion of isolates resistant to ceftriaxone fluctuated between 0.1% and 0.4%.

Citation(s):

Kirkcaldy RD et al. Trends in Neisseria gonorrhoeae susceptibility to cephalosporins in the United States, 2006-2014. JAMA 2015 Nov 3; 314:1869.