Author’s reply: The Russian gonococcal antimicrobial susceptibility programme (RU-GASP)--national resistance prevalence in 2007 and 2008, and trends during 2005-2008

摘要

We are grateful to Gil-Setas et al. for their comments on our paper [1]. In their letter “Spectinomycin in the treatment of gonorrhoea”, they further clarify and emphasise the importance of, if pos- sible, avoiding spectinomycin in the treatment of pha- ryngeal gonorrhoea, which is an important comment. Spectinomycin is an effective injectable antimicrobial [2] and is useful for treatment of patients with uncom- plicated anogenital gonorrhoea who, for example, can- not tolerate extended-spectrum cephalosporins or if extended-spectrum cephalosporins are not available. Fluoroquinolones have also been used in the past, but currently these are of limited importance for empirical treatment in most settings worldwide due to a high level of resistance [3]. However, it has been known for decades that spectinomycin is suboptimal (with some- times as low as approximately 50% effectiveness) for treatment of pharyngeal infections, due to the phar- macokinetic properties of spectinomycin [2,4-7]. This lower efficacy in eradicating Neisseria gonorrhoeae from the pharynx, compared with eradication of the bacteria in anogenital infection, is also a problem for several other antimicrobials [2,3,7], and it would be valuable to assess this issue in additional studies. In fact, among the antimicrobials available for treatment of uncomplicated gonococcal, including pharyngeal, infections, extended-spectrum cephalosporins and fluoroquinolones seem to have the best balance of proven efficacy and safety for wild-type, susceptible gonococci. However, as mentioned above fluoroqui- nolones are not recommended for use in most settings due to the high level of resistance [2,7].