Sulfonamide resistance in Neisseria meningitidis is mediated by altered forms of the chromosomal gene for the drug target enzyme dihydropteroate synthase. Sulfonamides have been used for decades both for prophylaxis and the treatment of meningococcal disease, and resistance is common. Two types of resistance determinants have been identified, and regions important for drug insusceptibility to the corresponding enzyme have been defined by site-directed mutagenesis. Both types of resistance traits have spread among strains of N. meningitidis of different serogroups and serotypes, and the large differences at the nucleotide level in a comparison of the resistance genes with the dhps genes of susceptible meningococci indicate the origin of one or maybe both types in other Neisseria species. One sulfonamide-sensitive strain of N. meningitidis was found to have a mosaic dhps gene with a central part identical to the corresponding part of a gonococcal strain. This observation supports the idea of an interspecies transfer of genetic material in Neisseria species as a mechanism for the development of chromosomally mediated resistance.Sulfonamides have played a very important part in antibacterial chemotherapy for 6 decades. Their target is the enzyme dihydropteroate synthase (DHPS) (EC 2.5.1.15), which catalyzes the formation of dihydropteroic acid in bacterial and some eucaryotic cells, but it is not present in human cells. This difference is the basis for the selective action of sulfonamide drugs, which act as competitive inhibitors of DHPS, thereby blocking folate biosynthesis in the bacterial cell (5). Sulfonamides are structural analogs to the normal substrate p-aminobenzoic acid and can indeed function as alternative substrates to produce a sulfa-containing pteroate analog (16,22). Chromosomal mutations in the dhps gene resulting in low levels of sulfonamide resistance (Ͻ0.05 mM) can be isolated in the laboratory (13,19), and naturally occurring resistance to high concentrations of sulfonamides (Ͼ0.5 mM) has been observed in gram-negative, enteric bacteria. This resistance is plasmid-borne and due to the presence of alternative drugresistant variants of the enzyme (23). Two such plasmid-encoded enzymes have been detected, and the nucleotide sequences of the corresponding genes have been determined (15,21,24).In Neisseria meningitidis, traits mediating high resistance (Ն0.5 mM) to sulfonamides were found to be located chromosomally (10,14). Most of the sulfonamide-resistant clinical strains of N. meningitidis were found to contain a dhps gene that was about 10% different from the corresponding gene in sulfonamide-sensitive isolates. From this large difference it was concluded that the resistance had been introduced by recombination rather than by mutation. One characteristic of these chromosomal resistance genes is an insertion of 6 bp, creating two extra codons in the sequence. Two sulfonamide-resistant strains of N. meningitidis differed in their sequences from this often-found form of resistance by lacking the 6-...