Emergence and Spread of Drug Resistant Neisseria gonorrhoeae

Purpose

The emergence and spread of Neisseria gonorrhoeae with resistance to oral antibiotics have led to difficulty in treating gonorrhea. We review drug resistance in N. gonorrhoeae with a particular emphasis on resistance to fluoroquinolones, cefixime and azithromycin.

Materials and Methods

Literature selected from peer reviewed journals listed in MEDLINE®/PubMed® from 1943 to 2009 and from resources cited in those articles was reviewed comprehensively.

Results

Due to the spread of fluoroquinolone resistant N. gonorrhoeae fluoroquinolones are no longer recommended for the treatment of gonorrhea. The emergence of N. gonorrhoeae with a mosaic penicillin-binding protein 2 associated with oral cephalosporin resistance has threatened cefixime treatment for gonorrhea. Emergence of N. gonorrhoeae with high level resistance to azithromycin has also been documented. However, injectable antibiotics (sepctinomycin and ceftriaxone) retain their activity against N. gonorrhoeae. To monitor drug resistance in N. gonorrhoeae several national and international programs have become functional.

Conclusions

Oral regimens for the treatment of gonorrhea are limited. At present to our knowledge ceftriaxone is the most reliable and available agent for the treatment of gonorrhea. To prevent the further emergence and international spread of drug resistance, and allow for the selection of appropriate treatments, a comprehensive global program is needed including surveillance for drug resistance in N. gonorrhoeae and collection of patient epidemiological data. Clinicians should effectively treat patients with gonorrhea, always being conscious of local trends of drug resistance in N. gonorrhoeae, and should perform culture and antimicrobial susceptibility testing in those with persistent gonorrhea after treatment.

Key Words: Neisseria gonorrhoeae, drug resistance, microbial, fluoroquinolones, cephalosporin resistance, azithromycin

Abbreviations and Acronyms: CDC, Centers for Disease Control and Prevention, CLSI, Clinical and Laboratory Standards Institute, GASP, Gonococcal Antimicrobial Surveillance Programme, GISP, Gonococcal Isolate Surveillance Project, MIC, minimum inhibitory concentration, NG-MAST, N. gonorrhoeae multi-antigen sequence type, PBP, penicillin-binding protein