Effectiveness of Cefixime for the Treatment of Neisseria gonorrhoeae Infection at 3 Anatomic Sites: A Systematic Review and Meta-Analysis

Abstract

Background: To treat Neisseria gonorrhoeae infection, the Centers for Disease Control and Prevention recommends a single oral dose of cefixime as an alternative to injectable ceftriaxone. Methods:We conducted a systematic review and meta-analysis to describe the effectiveness of cefixime in treating N. gonorrhoeae infection at 3 different anatomic sites.We searched PubMed and Embase database to abstract treatment success rates and cefixime dosage/frequency for studies that reported the anatomical site of infection. We included reports published between January 1, 1980, and December 7, 2021. Twenty studies published between 1989 and 2015 were included in our meta-analysis. We calculated pooled treatment success percentages and 95% confidence intervals (CIs) using random-effects models.Results: Of patients who received a 400-mg single dose of cefixime, 824 of 846 (97%; 95% CI, 96%-98%) patients with urogenital infection, 107 of 112 (97%; 95% CI, 84%-100%) patients with rectal infection, and 202 of 242 (89%; 95% CI, 76%-96%) patients with pharyngeal infection were cured. Of patients who received an 800-mg single dose of cefixime, 295 of 301 (98%; 95% CI, 96%-99%) patients with urogenital infection and 21 of 26 (81%; 95% CI, 61%-92%) patients with pharyngeal infection were cured. Conclusions:Our meta-analysis found that cefixime is highly effective at treating urogenital infections and less effective at treating pharyngeal infections.We recommend more investigation into the effectiveness of cefixime in treating rectal infections and studying multidose therapy for the cefixime treatment of pharyngeal infection.N eisseria gonorrhoeae infection is a public health concern worldwide, due in large part to the fact that N. gonorrhoeae has demonstrated unprecedented capacity to develop antibiotic resistance. 1 There is evidence of N. gonorrhoeae antimicrobial resistance to all recommended antimicrobial agents. 2,3 The Centers for Disease Control and Prevention (CDC) identified antimicrobial-resistant N. gonorrhoeae as 1 of the top 3 ongoing public health threats. 4 For those reasons, identifying effective therapies is critical for clinicians, public health professionals, and patients.Current recommendations for the treatment of gonorrhea rely on ceftriaxone as first-line therapy. In their 2020 European guidelines on the treatment of gonorrhea, the International Union against Sexually Transmitted Infections put forward 2 recommendations. The first International Union against Sexually Transmitted Infections recommendation was dual therapy of ceftriaxone 1 g intramuscularly as a single dose with azithromycin 2 g as a single oral dose. Their second recommendation was monotherapy of ceftriaxone 1 g intramuscularly alone. 5 The British Association for Sexual Health and HIV, in their 2018 guidelines on the treatment of infection with N. gonorrhoeae, also recommended ceftriaxone 1 g intramuscularly. 6 The CDC's 2020 update on treatment guidelines for gonococcal infection recommended a single intramuscular dose of ceftriaxone 500 mg ...

Alcohol Misuse and Sexually Transmitted Infections: Using the CAGE Questionnaire as a Screening Tool

“… 29 An Australian study found that people who abuse alcohol had a 1.6 times higher risk of contracting gonorrhea compared to people who did not abuse alcohol. 50 Given the consequences of untreated gonorrhea and the relative ease of treatment, 51 the CAGE questionnaire could be used as a tool for identifying people at risk who may benefit from further screening to receive earlier treatment.…”

2023 Korean Association of Urogenital Tract Infection and Inflammation guidelines for gonococcal infection

“…The 800 mg oral dose of cefixime should only be considered as an alternative therapy to cephalosporins because it does not provide as high or sustained blood bactericidal levels as ceftriaxone 500 mg IM [ 32 ]. It also shows limited efficacy for treating of pharyngeal gonorrhea (81% cure, 95% confidence interval 61%–92%) [ 33 ]. In particular, sensitivity of gonorrhoeae isolated in Korea to cefixime decreased from 91% in 2018 to 77% in 2019 [ 30 ].…”

Rhynchophorus ferrugineus larvae: A novel source for combating broad-spectrum bacterial and fungal infections

“…This antibiotic is oftentimes used for the therapeutic management of cutaneous or skin infections and its associated conditions such as acne vulgaris [77][78][79] as well as sexually transmitted infections (STIs), such as gonorrhea, caused by the pathogenic Gram-negative bacteria Neisseria gonorrhoeae [80,81], either on its own or in combination with other medications such as gemifloxacin, gentamicin, and extended-spectrum cephalosporins [82][83][84]. Cefixime (as an alternative to ceftriaxone) is another well-known antibiotic that is utilized for the treatment of gonorrhea and is also efficacious against a vast array of both Gram-positive and Gram-negative bacteria, such as all strains of group A Streptococci, Haemophilus influenzae, E. coli, and Moraxella catarrhalis, regardless of their β-lactamase production status, as well as strains of pneumococci that are penicillin sensitive [85][86][87]. Clindamycin is a medication used for the treatment of skin and skin structure infections as well as intra-abdominal infections, lower respiratory, gynecological, bone and joint infections, and septicemia [88].…”