A Comparison of Single-Dose Cefixime with Ceftriaxone as Treatment for Uncomplicated Gonorrhea

Handsfield, H. Hunter; McCormack, William M.; Hook, Edward W.; Douglas, John M.; Covino, Jean; Verdon, Michael; Reichart, Cindy A.; Ehret, Josephine M.

doi:10.1056/nejm199111073251903

Cited by 112 publications

(39 citation statements)

References 21 publications

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“…[8][9][10] For the present regimen, we used pharmacokinetic parameters for cefixime to simulate the period of time during which the serum concentration would be four times higher than each of a series of assumed MIC 90 s of cefixime for N. gonorrhoeae. According to the criterion proposed by Moran and Levine, 7 this regimen would no longer be effective in the treatment of gonococcal urethritis when the MIC 90 s were Ն0.125 µg/ml, because the therapeutic times were less than 10 h. When we planned this study in 1999, the MIC 90 s for cefixime for clinical isolates of N. gonorrhoeae were 0.06 to 0.125 µg/ml in Japan.…”

Section: Discussionmentioning

confidence: 99%

“…17 In Japan, where the efficacy of oral regimens with fluoroquinolone and cephalosporin is failing, 11,18 the emergence of resistance to ceftriaxone and specinomycin in clinical strains of N. gonorrhoeae, which would be disastrous for the treatment of gonococcal infections, must be prevented. At the same time, because oral regimens are clinically more convenient for the treatment of gonococcal urethritis, new oral regimens, including a single-dose regimen with an increased dose of cefixime; for example, a single dose of 800 mg cefixime or more, 9,[19][20][21][22] must be developed.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Clinically, this regimen is highly effective in the treatment of uncomplicated gonococcal urethritis in the United States. 9,10 In contrast, a decrease in the susceptibilities of current clinical isolates of N. gonorrhoeae to oral cephalosporins, including cefixime, has been observed in Japan. 11 If the MIC 90 of cefixime for gonococcal strains were increased, the therapeutic time of a single 400-mg dose of cefixime could be less than 10 h. Therefore, we attempted to develop a new dosing regimen for the drug to extend the therapeutic time.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Treatment of uncomplicated gonococcal urethritis by double-dosing of 200mg cefixime at a 6-h interval

Deguchi

Yasuda

Yokoi

et al. 2003

Journal of Infection and Chemotherapy

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of uncomplicated gonococcal urethritis by double-dosing of 200mg cefixime at a 6-h interval

Deguchi

Yasuda

Yokoi

et al. 2003

Journal of Infection and Chemotherapy

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“…Sporadic instances of per- sistent pharyngeal infection unrelated to MICs of ceftriaxone occurred during the study period (9), but persistence of infection with the same strain following treatment with 125 mg of ceftriaxone was well documented in only one instance. This was a pharyngeal infection with pre-and posttreatment isolates susceptible to 0.015 g of ceftriaxone per ml.…”

Section: Resultsmentioning

confidence: 97%

Trends in susceptibility of Neisseria gonorrhoeae to ceftriaxone from 1985 through 1991

Schwebke

Whittington

Rice

et al. 1995

Antimicrob Agents Chemother

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The antimicrobial susceptibilities of 16,441 gonococcal isolates from Seattle-King County were determined for ceftriaxone, cefoxitin, penicillin G, and tetracycline. From 1985 to 1989, ceftriaxone, in combination with doxycycline, was increasingly used for treatment of gonorrhea, and by 1989, it was used as therapy for >80% of cases in Seattle-King County. MICs of ceftriaxone correlated significantly (P < 0.001) with those of the other beta-lactam antibiotics included in this study. Geometric mean MICs of penicillin G for isolates that did not produce ␤-lactamase increased from 1985 to 1991. The geometric mean MICs of cefoxitin, ceftriaxone, and tetracycline began to decline in 1987 but increased in 1990 and 1991. The percentage of strains with decreased susceptibility to ceftriaxone (MIC, 0.06 to 0.25 g/ml) rose from 0.3% in 1985 to 5.3% in 1987 but subsequently declined steadily to 2.6% in 1991, despite increased use of ceftriaxone as routine therapy for gonorrhea. Changes in patterns of antimicrobial susceptibility may be related not only to antimicrobial selection pressures but also to less well understood population shifts among Neisseria gonorrhoeae strains within a community.Neisseria gonorrhoeae has consistently developed resistance to the antimicrobial agents used for the treatment of gonorrhea (23). An excellent example of the effects of antibiotic selection pressure occurred in Korea, where penicillin resistance prompted primary therapy with spectinomycin, only to be followed by development of resistance to this antibiotic (1).In 1989, the Centers for Disease Control (Atlanta, Ga.) recommended ceftriaxone given as a single intramuscular dose of 250 mg as primary therapy for gonorrhea (3). Although a 125-mg dose of ceftriaxone had proven effective in clinical trials (8, 15), it was not widely recommended because of concern regarding the development of resistance to this antimicrobial agent with the use of the smaller dose (3). However, the Seattle-King County Department of Public Health Sexually Transmitted Diseases (STD) Clinic at Harborview Medical Center employed ceftriaxone in a dose of 125 mg given intramuscularly, followed by doxycycline, 100 mg twice daily by mouth for 7 days, since 1985. By mid-1987, this regimen became the standard therapy for gonorrhea in the STD clinic. By 1989, over 80% of the gonorrhea cases in both public clinics and the private sector in Seattle-King County were treated with ceftriaxone and doxycycline, and this remained the most commonly used therapy for gonorrhea through 1991.A laboratory surveillance system for gonococcal antimicrobial susceptibility was implemented in Seattle-King County in late 1985, since which time Ͼ80% of gonococcal isolates from reported cases have been referred to the Neisseria Reference Laboratory for antimicrobial susceptibility testing. This surveillance system permitted the assessment of the relationship of widespread ceftriaxone therapy for gonorrhea to trends in susceptibility of N. gonorrhoeae to ceftriaxone and other antibiotics. MATERI...

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“…The U.S. Centers for Disease Control and Prevention (CDC) recommends dual therapy with ceftriaxone (single dose of 250 mg) and azithromycin (single dose of 1 g orally) for the treatment of uncomplicated gonococcal infections (1). Although treatment with ceftriaxone is safe and effective at all anatomic sites, with cure rates of Ͼ98% in clinical trials (8,9), N. gonorrhoeae isolates with ESC MICs in the alert ranges defined by the CDC (cefpodoxime [CPD] MIC, Ն0.25 g/ml; cefixime [CFM] MIC, Ն0.25 g/ml; or ceftriaxone [CRO] MIC, Ն0.125 g/ml) are being reported with increasing frequency (7,(10)(11)(12)(13)(14). These alert values are lower than the nonsusceptible breakpoints set forth by Clinical and Laboratory Standards Institute (CLSI) (CPD, Ͼ0.25 g/ml; CFM, Ͼ0.25 g/ml and CRO, Ͼ0.25 g/ml) and are used by the CDC as criteria for the surveillance of decreased susceptibility to ESCs.…”

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confidence: 99%

Real-Time PCR Targeting the penA Mosaic XXXIV Type for Prediction of Extended-Spectrum-Cephalosporin Susceptibility in Clinical Neisseria gonorrhoeae Isolates

Wong

Hemarajata

Soge

et al. 2017

Antimicrob Agents Chemother

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Neisseria gonorrhoeae isolates with decreased susceptibility to extendedspectrum cephalosporins (ESCs) are increasing. We developed an assay to predict N. gonorrhoeae susceptibility to ESCs by targeting penA mosaic XXXIV, an allele prevalent among U.S. isolates with elevated ESC MICs. The assay was 97% sensitive and 100% specific for predicting at least one ESC MIC above the CDC alert value among clinical isolates, and it could be multiplexed with a previously validated gyrA PCR to predict ciprofloxacin susceptibility.

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A Comparison of Single-Dose Cefixime with Ceftriaxone as Treatment for Uncomplicated Gonorrhea

Abstract: In the treatment of uncomplicated gonorrhea, a single dose of cefixime (400 or 800 mg) given orally appears to be as effective as the currently recommended regimen of ceftriaxone (250 mg given intramuscularly).

Cited by 112 publications

References 21 publications

Treatment of uncomplicated gonococcal urethritis by double-dosing of 200mg cefixime at a 6-h interval

Treatment of uncomplicated gonococcal urethritis by double-dosing of 200mg cefixime at a 6-h interval

Trends in susceptibility of Neisseria gonorrhoeae to ceftriaxone from 1985 through 1991

Real-Time PCR Targeting the penA Mosaic XXXIV Type for Prediction of Extended-Spectrum-Cephalosporin Susceptibility in Clinical Neisseria gonorrhoeae Isolates

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