Penicillin Therapy in Sulfonamide-Resistant Gonorrhea in Men

Slyke, C. J. Van; Arnold, R. C.; Buchholtz, Maurice

doi:10.2105/ajph.33.12.1392

Cited by 18 publications

(11 citation statements)

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“…However, it took until 1943 before this "wonder drug" was appropriately documented to be therapeutically effective for gonococcal urethritis, and penicillin subsequently marked a new era in the treatment of gonorrhea as well as other infectious diseases (83,84). Penicillin quickly supplanted the sulfonamides as the first-line treatment of gonorrhea (83,85). Penicillin cured more than 95% of cases, with total doses as low as 45 mg being used (85).…”

Section: The Antimicrobial Eramentioning

confidence: 99%

“…Penicillin quickly supplanted the sulfonamides as the first-line treatment of gonorrhea (83,85). Penicillin cured more than 95% of cases, with total doses as low as 45 mg being used (85). However, over time, the MICs of penicillin against gonococcal strains increased due to an accumulation of chromosomal resistance determinants, and the prescribed doses were progressively increased to obtain appropriate cure rates (8,63,(86)(87)(88)(89).…”

Section: The Antimicrobial Eramentioning

confidence: 99%

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Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

2014

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SUMMARY Neisseria gonorrhoeae is evolving into a superbug with resistance to previously and currently recommended antimicrobials for treatment of gonorrhea, which is a major public health concern globally. Given the global nature of gonorrhea, the high rate of usage of antimicrobials, suboptimal control and monitoring of antimicrobial resistance (AMR) and treatment failures, slow update of treatment guidelines in most geographical settings, and the extraordinary capacity of the gonococci to develop and retain AMR, it is likely that the global problem of gonococcal AMR will worsen in the foreseeable future and that the severe complications of gonorrhea will emerge as a silent epidemic. By understanding the evolution, emergence, and spread of AMR in N. gonorrhoeae , including its molecular and phenotypic mechanisms, resistance to antimicrobials used clinically can be anticipated, future methods for genetic testing for AMR might permit region-specific and tailor-made antimicrobial therapy, and the design of novel antimicrobials to circumvent the resistance problems can be undertaken more rationally. This review focuses on the history and evolution of gonorrhea treatment regimens and emerging resistance to them, on genetic and phenotypic determinants of gonococcal resistance to previously and currently recommended antimicrobials, including biological costs or benefits; and on crucial actions and future advances necessary to detect and treat resistant gonococcal strains and, ultimately, retain gonorrhea as a treatable infection.

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Section: The Antimicrobial Eramentioning

confidence: 99%

Section: The Antimicrobial Eramentioning

confidence: 99%

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

2014

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“…Penicillin was discovered accidently by Fleming in 1928, but it took until 1943 before penicillin was adequately validated to be highly effective for gonococcal urethritis. Penicillin rapidly became the recommended first-line treatment for gonorrhea (36, 37). However, during the following decades the penicillin MICs in gonococcal strains increased, due to emergence of chromosomal AMR determinants, and the recommended doses had to be progressively increased for cure (12, 16, 38, 39–44).…”

Section: Antimicrobial Resistance In Neisseria Gonorrhoeaementioning

confidence: 99%

Antimicrobial Resistance Expressed by Neisseria gonorrhoeae : A Major Global Public Health Problem in the 21st Century

2016

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Neisseria gonorrhoeae is a strictly human pathogen that is typically transmitted by sexual contact. The associated disease gonorrhea has plagued humankind for thousands of years, with a current estimated incidence of 78 million cases per year. Advances in antimicrobial discovery in the 1920s and 1930s leading to the discovery of sulfonamides and penicillin begun the era of effective antimicrobial treatment of gonorrhea. Unfortunately, the gonococcus developed decreased susceptibility or even resistance to these initially employed antibiotics, a trend that continued over subsequent decades with each new antibiotic that was brought into clinical practice. As this pattern of resistance has continued into the 21st century, there is now reason for great concern, especially in an era when few new antibiotics have prospects for use as treatment of gonorrhea. Here, we review the history of gonorrhea treatment regimens and gonococcal resistance to antibiotics, the mechanisms of resistance, resistance monitoring schemes that exist in different international settings, global responses to the challenge of resistance, and prospects for future treatment regimens in the 21st century.

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“…Although initially reserved for sulphonamide-resistant cases, penicillin subsequently became the drug of choice for gonorrhoea 12–14. Initially, cure rates with penicillin exceeded 95% and total doses as low as 45 mg were prescribed owing to scarcity and the high cost of the drug 13. Over time, gonococci became less susceptible as penicillin minimum inhibitory concentrations (MICs) rose, requiring higher doses to effect cure 15–17.…”

Section: Penicillinsmentioning

confidence: 99%

The Gonococcus fights back: is this time a knock out?

Lewis

2010

Sexually Transmitted Infections

129

161

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Since the introduction of antibiotics in the 1930s, Neisseria gonorrhoeae has exhibited a remarkable ability to acquire novel genetic resistance determinants. Initially, sulphonamides were replaced by penicillin, while tetracyclines were prescribed for penicillin-allergic patients. With the advent of penicillinase-producing gonococci, spectinomycin was only briefly useful as alternative treatment and plasmid-mediated tetracycline resistance spread rapidly from the mid-1980s onwards. The fluoroquinolones followed but chromosomally mediated resistance appeared after only a decade of use. Seventy years on, we now face a global public health challenge of immense significance--the emergence of resistance to cephalosporins. With lack of investment in the search for new anti-gonococcal antimicrobial agents or vaccine research, the global spread of multiresistant gonococci can be seen. The impact of untreatable gonorrhoea on HIV transmission could be enormous in high-prevalence countries. This threat comes at a time when many national STI control programmes are weak. To delay the emergence of extensively drug-resistant gonorrhoea, public health systems require strengthening and novel strategies need implementing to enhance the therapeutic lifespan of the few antimicrobial agents that we have left.

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Penicillin Therapy in Sulfonamide-Resistant Gonorrhea in Men

Cited by 18 publications

References 0 publications

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

Antimicrobial Resistance Expressed by Neisseria gonorrhoeae : A Major Global Public Health Problem in the 21st Century

The Gonococcus fights back: is this time a knock out?

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