Point-of-care antibiotic susceptibility testing for gonorrhoea: improving therapeutic options and sparing the use of cephalosporins.

摘要

Antimicrobial therapy for Neiserria gononhoeae is a major public health concern with high rates of resistance to penicillin, tetracycline and fluoro-quinolones detected in England and Wales in the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) (GRASP 2008 Report: Trends in Antimicrobial Resistant Gonorrhoea. Health Protection agency, http://www.hpa.org.uk/ Publications/InfectiousDiseases/HIVAndSTIs/ 0906GRASP2008/ last accessed 26 July 2010). Currently third-generation oral cephalosporins, such as cefixime or injectable ceftriaxone, are recommended as first-line therapy. However, low-level increases in minimum inhibitory concentrations (MIC) for cephalosporins are now widely reported, and reports of azithromycin resistance2 further highlight reduced therapeutic options. Recommendations to limit spread of cephalosporin resistance may well include combination and even prolonged therapy, but these undermine clinical desirability for a single observable dose.