High incidence of treatment failure of Neisseria gonorrhoeae isolates to ciprofloxacin in male gonococcal urethritis in Delhi

Abstract

Several treatment failures and widespread antimicrobial resistance to ciprofloxacin have been documented, subsequent to its initial recommendation in 1989 as a single dose alternative therapy for gonorrhoea. Still, it continues to be part of various treatment schedules in National STD control guidelines including India. This prompted us to study the current status of this drug in the treatment of gonorrhoea. Thirty-five male patients with gonococcal urethritis were included in the study. The susceptibility to penicillin, tetracycline, ciprofloxacin and ceftriaxone was determined by Kirby-Bauer disc diffusion method and minimum inhibitory concentration (MIC) of ciprofloxacin by agar plate dilution method. The clinical and bacteriological response was assessed on day 5 after treatment with single dose ciprofloxacin, 500 mg. The sensitivity pattern of Neisseria gonorrhoeae was observed to be: ceftriaxone 100%, azithromycin 100%, tetracycline 65.7%, penicillin 40% and ciprofloxacin 5.7% by disc diffusion method. The MIC for ciprofloxacin was below 0.06 microg/mL (sensitive) in one (2.5%) isolate only. On the fifth day a large number of treatment failures (88.5%) were seen with ciprofloxacin while none was noted one week after re-treatment with ceftriaxone. The location of endemic quinolone-resistant N. gonorrhoeae (QRNG) in New Delhi has increased alarmingly, resulting in an extremely high proportion of therapeutic failures, and thus requiring appropriate alterations in the presently recommended treatment regimens.

Emergence of quinolone-resistant Neisseria gonorrhoeae in Pakistan

“…1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 On correlating the in vitro resistance to clinical response (despite the small number of patients), there appears to be a clear association between QRNG isolates and failure to treatment with quinolones. This observation is consistent with earlier reports from Bangladesh, 11 India 19 and Israel 20 that have also shown a good correlation between in vitro resistance and treatment failures.…”

Evaluation of the in vitro activity of six antimicrobial agents against Neisseria gonorrhoeae

“…As far as penicillin is concerned, the non-PPNG strains presented an intermediated susceptibility, with a tendency to increase in susceptibility to this drug with time, although the obtained results are inferior to those found by CHOWDRY et al 6 and SHIGEMURA et al 22 . Regarding ofloxacin, we identified only 8% resistance among the non-PPNG strains, a much inferior result than those reported in the world literature, which oscillate between 70% and 90% of resistance 2,20,27 , these probably being the first resistant strains identified in Brazil.…”

Ciprofloxacin-ResistantNeisseria meningitidis, Delhi, India

“…In addition to chemoprophylaxis, fluoroquinolone consumption in the community, for a range of infections may be, in part, responsible for the emergence of ciprofloxacin resistance in N. meningitidis isolates. Lack of N. gonorrhoeae isolate response to ciprofloxacin has been reported in Delhi ( 13 ). Drift in susceptibility of N. gonorrhoeae to ciprofloxacin caused therapeutic failure.…”