Sensitivity of N. Gonorrhoeae to Antibiotics

Abstract

Since the late thirties, physicians have been in a very fortunate position with regard to the therapy of gonorrhoea. At that time the sulphonamide drugs were discovered and produced a revolution in the treatment of gonorrhoea; when the incidence of resistant gonococcus strains became too high, penicillin came into the picture, closely followed by streptomycin and tetracycline. In addition, other antibiotics have a considerable effect on the gonococcus in vivo and in vitro (chloromycetin, erythromycin, oleandomycin, syntomycin, novobiocin, kanamycin, etc.); yet, in spite of the decreasing clinical effect and the increasing incidence of allergic response, the drug of choice has been and still is penicillin. Certain disadvantages exist for most of the other antibiotics, and they cannot be recommended, at least not for large-scale routine treatment or for use alone. Factors relevant in this connexion are: cost, method of application, toxicity, tendency to development of less sensitive or resistant strains, and selective effect on other bacteria such as the staphylococci and klebsiellae.It is well known that complete resistance to streptomycin develops very easily, and it was recently shown by Meyer-Rohn (1958) that gonococci can be made completely resistant to erythromycin and oleandomycin, and that some resistance to tetracycline can also be developed.In this paper the problems of sensitivity and treatment are considered mainly from the bacteriological point of view. The considerations are based upon work done at the Statens Seruminstitut in Copenhagen and it is not intended (to any great extent) to refer to other similar work. The gonococcus department of the Statens Seruminstitut in Copenhagen serves as a centre for the entire country, about 100,000 specimens being received each year; about 10-12 per cent. result in positive cultures, 80 per cent. being from women and 20 per cent. from men (10,000 to 12,000 positive cultures per year). PenicillinLate in 1955 four gonococcal strains were isolated from a case of uncomplicated gonorrhoea which was refractory to repeated "ordinary" penicillin treatment; all four strains showed a sensitivity to penicillin twenty times lower than usual. The lowered sensitivity persisted, and after the usual dose of penicillin the patient's serum showed levels similar to those commonly observed. This observation, together with the increasing use of oral penicillin, and the increasing number of allergic cases, made it desirable to review the sensitivity of gonococci to penicillin and to other possible antibiotics. In addition, a few reports were found from other countries, in which a change in the distribution of the in vitro concentrations necessary for complete in vitro inhibition was described.Preliminary testing by means of the tablet method of 300 strains isolated in 1956 showed that 10 per cent. of these strains were about twenty times less sensitive than usual.The department possessed a collection of freezedried strains, among which a high number had been isolated and dried befor...

Properties of ß-lactamase from Neisseria gonorrhoeae

“…Remarkably small doses (e.g., 100,000 units altogether) were used to cure gonorrhoea (Mahoney et al 1945), an occurrence reflecting the high susceptibility of the gonococcus to penicillin (Reyn et al 1958). During the subsequent decades a gradual increase in gonococcal resistance to penicillin, documented in the United States (Martin et al 1970) and elsewhere (Amies 1969, Reyn 1961, Arya & Phillips 1979, needed increases in the dose of penicillin as well as the addition of probenecid to maintain effective therapy (Holmes et al 1973, Kaufman et al 1976). In the United States, however, a reduction in gonococcal resistance to penicillin has been witnessed since 1972 (Reynolds et al 1976), and in 1976 a substantial decline in the rate of increase in morbidity from gonorrhoea was observed (CDC 1977).…”

Multiple Antibiotic Resistance in Neisseria gonorrhoeae

“…In 1961, Reyn reported that gonoccal isolates resistant to penicillin were likely to be resistant to tetracycline and streptomycin (8). Since then, other workers have found that gonococcal isolates resistant to penicillin also tended to be resistant to erythromycin (10), chloramphenicol (1), fusidic acid (10), and rifampin (7), as well as some nonantibiotics, acridine orange and ethidium bromide (6).…”

Acquired Macrolide Resistance Genes in Pathogenic Neisseria spp. Isolated between 1940 and1987

“…Although erythromycin and azithromycin, in the 1-g dose, are not recommended for treatment of gonococcal infection, azithromycin has been used in some parts of the world to treat gonorrhea (7,30). Increased gonococcal resistance to erythromycin has been noted since the 1960s (19), and resistance to azithromycin has been recently identified (7,13). Gonococcal resistance to erythromycin has been linked to resistance to killing by fecal lipids, and such resistant strains are more likely to be recovered from men who have sex with men than from heterosexual men (9).…”