Cefixime-resistant Neisseria gonorrhoeae in the UK: a time to reflect on practice and recommendations

Abstract

A 40-year-old man who has sex with men (MSM) with urethral gonorrhoea failed to respond to treatment with 400 mg cefixime orally. Laboratory isolation of the post-treatment strain showed a minimum inhibitory concentration of ≥0.25 mg/L, which is a level of tolerance to cefixime that has not been previously documented in the UK. This case illustrates the importance of assessing all patients after treatment for gonorrhoea so that treatment failure and antibiotic resistance can be identified. It is vital that gonorrhoea culture continues to be attempted from all infected individuals to enable accurate diagnosis and antibiotic sensitivities. We also recommend that laboratories test for cefixime sensitivity routinely, given that it is one of the most commonly prescribed treatments for gonorrhoea.

The threat of untreatable gonorrhoea: implications and consequences for reproductive and sexual morbidity

“…However, resistance to this class of antimicrobials is also now emerging and numerous cases of treatment failure with cefixime, have been reported -first from Japan, followed by other parts of the world. [15][16][17][18] The recent report of a highly ceftriaxone-resistant strain of N. gonorrhoeae in Japan sounded alarm bells of significant future challenges. 19 In the Asia-Pacific and European regions, for instance, gonococci have been observed to need increased concentrations of antibiotics to stop them multiplying.…”

The use of cephalosporins for gonorrhea: an update on the rising problem of resistance

“…The first failures in treatment with oral ESCs were reported several years ago in Japan, 25, 26 , however more recently there have been oral ESC failures described in Hong Kong, 27 England, 28, 29 Austria, 30 Norway, 31 and France. 2 Much of the spread of cefixime-resistant gonorrhea appears to be a result of the dissemination of resistant clones, of which N. gonorrhoeae multiantigen sequence typing ST1407 is particularly common.…”

Expedited partner therapy for sexually transmitted infections

“…In the last decade, decreased in-vitro susceptibility to cephalosporins has been observed in Asia, Europe, and North America [26][27][28][29][30][31] and oral cefixime treatment failures have been reported from Japan and several countries in Western Europe [32][33][34][35][36][37][38]. N. gonorrhoeae has progressively acquired resistance to each antibiotic previously recommended for treatment: sulfonamides, penicillin, tetracycline, and, most recently, fluoroquinolones.…”