by Playfuls Staff |
13th April 2007
CDC no longer recommends antibiotics known as
fluoroquinolones (ciprofloxacin, ofloxacin, and levofloxacin) as a treatment
for gonorrhea in the
United
States. This limits the options available to
treat [more] gonorrhea, one of the most common sexually transmitted diseases in
the
United States.
The recommendation was prompted by new data released in
CDC’s Morbidity and Mortality Weekly Report (MMWR) showing that
fluoroquinolone-resistant gonorrhea is now widespread in the United States
among heterosexuals and men who have sex with men (MSM). The data showed the
proportion of drug-resistant cases among heterosexuals rising above the
recognized threshold of 5 percent for changing treatment recommendations. CDC
had recommended fluoroquinolones no longer be used to treat gonorrhea in MSM
when this threshold was crossed in earlier years.
The new data, from CDC’s Gonococcal Isolate Surveillance
Project (GISP) in 26 U.S.
cities, showed that among heterosexual men, the proportion of gonorrhea cases
that were fluoroquinolone-resistant Neisseria gonorrhoeae (QRNG) reached 6.7
percent in the first half of 2006, an 11-fold increase from 0.6 percent in
2001.
Recommended options for treating gonorrhea are now limited
to a single class of antibiotics known as cephalosporins. Public health
officials believe the lack of treatment options underscores the need for
accelerated research into new drugs, as well as increased efforts to monitor
for emerging drug resistance, especially to cephalosporins.
While significant resistance to cephalosporins has not been
observed to date, CDC is working with state and local health departments to
monitor emerging cephalosporin resistance. CDC is urging health departments to
maintain or develop capacity to perform cultures for Neisseria gonorrhoeae and
to assess any gonorrhea treatment failures for possible resistance. In
addition, CDC is working with the World Health Organization to strengthen
international efforts to monitor for the emergence of cephalosporin resistance
and with government and industry partners to identify and evaluate promising
new drug regimens. These additional measures are critical for the control of
gonorrhea.
Oral fluoroquinolones were recommended as first-line
treatments for gonorrhea in 1993. But drug resistant cases have increased
steadily in recent years, rising first in the western United States
and then among MSM nationwide. In 2002, CDC recommended that fluoroquinolones
not be used to treat gonorrhea infections acquired in California and Hawaii,
and in 2004 that the drugs no longer be used to treat MSM with these
infections.
The new CDC analysis shows an increase in the past five
years in the overall proportion of gonorrhea cases that are
fluoroquinolone-resistant – from less than 1 percent in 2001 to 13.3 percent in
the first half of 2006. The analysis also indicated that fluoroquinolone
resistance is widespread geographically. Resistant cases were seen across the United States in the first half of 2006 (in 25
of the 26 cities in the analysis), and sharp increases occurred from 2004 to
2006 in several cities, including Philadelphia
(from 1.2 percent to 26.6 percent of gonorrhea cases) and Miami (from 2.1 percent to 15.3 percent). In
addition, the analysis showed QRNG continued to rise among MSM; 38 percent of
MSM gonorrhea cases were QRNG in the first half of 2006, compared to 1.6
percent in 2001.
Within the class of cephalosporins, CDC now recommends
ceftriaxone, available as an injection, the preferred treatment for all types
of gonorrhea infection (genital, anal, and throat).
