Temporal Trends in Gonococcal Antibiotic Resistance in Baltimore

Reichart, Cindy A.; Neumann, Theresa; Foreman, Phyllis; Zenilman, Jonathan M.; Hook, Edward W.

doi:10.1097/00007435-199207000-00006

Cited by 21 publications

(11 citation statements)

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“…Organisms with CMR had markedly decreased susceptibilities to all antimicrobial agents. Ceftriaxone MICs were higher for this sample than for isolates from previous years, probably representing the continued evolution of low-level resistance, which has been observed previously (6). Organisms with CMR also had decreased susceptibilities to the macrolides, including azithromycin.…”

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confidence: 54%

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Antibacterial activities of OPC-17116, ofloxacin, and ciprofloxacin against 200 isolates of Neisseria gonorrhoeae

Zenilman

Neumann

Patton

et al. 1993

Antimicrob Agents Chemother

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OPC-17116 is a new fluoroquinolone with potent activity against aerobic and anaerobic organisms. We evaluated the susceptibilities of 200 clinical gonococcal isolates including organisms with plasmid and chromosomally mediated resistance to beta-lactams and tetracycline. The antibiotics studied included OPC-17116, ofloxacin, ciprofloxacin, penicillin, tetracycline, erythromycin, azithromycin, and ceftriaxone. All isolates tested were susceptible to the quinolone class of antibiotics. The MICs of ciprofloxacin, ofloxacin, and OPC-17116 for 90% of isolates tested were 0.004, 0.03, and 0.004 micrograms/ml, respectively. For organisms with chromosomally mediated resistance to penicillin and tetracycline, geometric mean MICs of all antibiotics including the quinolones were increased.

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confidence: 54%

“…MICs of ceftriaxone were greater than those reported in previous studies from 1987 to 1989 (6). Between 1987 and 1989, the MIC of ceftriaxone for 50% of organisms tested (MIC50) was 0.004 ,ug/ml; in 1990 and 91, the MIC50 was 0.015 p,g/ml.…”

mentioning

confidence: 61%

Antibacterial activities of OPC-17116, ofloxacin, and ciprofloxacin against 200 isolates of Neisseria gonorrhoeae

Zenilman

Neumann

Patton

et al. 1993

Antimicrob Agents Chemother

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“…The absolute population size, reflected by Baltimore clinical case incidence rates, significantly declined from 1977 to 2005. In addition to this decrease in the census population, another factor that may have contributed to the 1985-90 decline in effective population size is the well-documented increase in prevalence of penicillinase-producing N. gonorrhoeae (PPNG) and chromosomally mediated penicillin resistance in Baltimore from 1986-1990(Reichart et al, 1992. A selective sweep by antibiotic resistant strains would be predicted to cause a decrease in the effective population size.…”

Section: Discussionmentioning

confidence: 99%

Temporal trends in gonococcal population genetics in a high prevalence urban community

Pérez‐Losada

Crandall

Zenilman

et al. 2007

Infection, Genetics and Evolution

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Molecular evolutionary studies can provide insights into the spread of infectious diseases and inform infection control measures. We performed a population genetic analysis of gonococcal isolates obtained over a 15-year interval in Baltimore MD, where gonorrhea is highly prevalent. Categorical analysis of genetic differentiation revealed temporal structuring of the gonococcal population. The use of a new method to determine the historical demography of N. gonorrhoeae from sequence data showed a strong correlation with trends in the number of reported cases of N. gonorrhoeae and, in addition, may reflect the influence of social and demographic factors and the impact of antimicrobial resistance on the molecular epidemiology of gonorrhea in Baltimore over the past two decades. The strong correlation between the population genetic inferences over the last twenty years and the demographic data collected over the same time period demonstrates the utility of these approaches for the accurate inference of complex population dynamics using multilocus sequence data. The real time application of population genetic analysis can provide sentinel data on gonococcal prevalence, antibiotic resistance patterns and changing epidemiology of gonococcal infections.

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“…In one of the cities participating in this study (Baltimore), ciprofloxacin (500 mg) has been the drug of choice for treatment of uncomplicated gonorrhea since November 1988. In this setting, despite widespread use, clinically significant quinolone resistance has yet to be described (11). Taken in combination, these data, as well as prior reports of treatment efficacy for males (7,12,14) suggest that ciprofloxacin, like other quinolone antibiotics proven effective for treatment of uncomplicated gonorrhea, may be able to make an important contribution to the therapeutic armamentarium for patients, particularly when cost is considered.…”

Section: Discussionmentioning

confidence: 83%

Comparison of ciprofloxacin and ceftriaxone as single-dose therapy for uncomplicated gonorrhea in women

Hook

Jones

Martín

et al. 1993

Antimicrob Agents Chemother

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Although women bear. the brunt of gonococcal infection-related morbidity, few large studies of gonorrhea treatment in women have been conducted. In a multicenter, double-blind, placebo-controlled trial, 181 evaluable women with uncomplicated gonorrhea were treated with ciprofloxacin (250 mg orally; 94 women) or ceftriaxone (250 mg intramuscularly; 87 women). Twenty-four percent of the participants were infected with antibiotic-resistant Neisseria gonorrhoeae. Cervical gonorrhea was cured in 100%o (93 of 93) of the women treated with ciprofloxacin and 99% (83 of 84) receiving ceftriaxone. All pharyngeal (n = 5) or rectal (n = 20) infections treated with ciprofloxacin were cured, as were ceftriaxone-treated patients with pharyngeal (n = 6) or rectal (n = 21) infection. Geometric mean MICs (range) for 248 pretreatment isolates were: penicillin, 0.28 (0.015 to 8.0); tetracycline, 0.46 (0.06 to 4); ciprofloxacin, 0.003 (0.002 to 0.015); and ceftriaxone, 0.004 (0.001 to 0.125) ,ug/ml. Both drugs were well tolerated. Despite the high prevalence of antibiotic-resistant gonococci in these populations, 250 mg of oral ciprofloxacin was as effective as an injection of ceftriaxone.Despite the more than 30% decline in gonorrhea cases reported in the decade of the 1980s, infections due to Neisseria gonorrhoeae continue to be the most common reportable bacterial disease in the United States (5). The proportion of isolates resistant to penicillin or tetracycline also has increased dramatically.Although not yet a major problem in the United States, development of resistance to alternative therapies such as spectinomycin or even the newer quinolones is a continuing concern (1, 5, 15). In addition, gonorrhea rates tend to be highest in Americans aged 15 to 24 years, but late consequences which disproportionately affect women (e.g., infertility, ectopic pregnancy) often do not become apparent until years after the acute infection. Paradoxically, while gonorrhea and its sequelae tend to most profoundly affect females, studies of gonorrhea therapy predominantly report data for men. To provide more data on the treatment of gonorrhea in women and on the utility of ciprGfloxacin, a currently recommended alternative to ceftriaxone for gonorrhea treatment, we conducted a prospective, multicenter, randomized, double-blind, placebo-controlled trial comparing 250 mg of oral ciprofloxacin with 250 mg of intramuscular ceftriaxone for therapy of uncomplicated gonorrhea in women attending sexually transmitted disease (STD) clinics. MATERIALS AND METHODSStudy design. The study was a prospectively conducted, randomized, double-blind, placebo-controlled trial in which all participants received both an injection and a single oral dose of medication. All medications were administered by a third party who had been instructed not to inform the study * Corresponding author.clinician of the therapeutic regimen utilized. Patients randomized to ciprofloxacin therapy received one 250-mg tablet of ciprofloxacin orally and an injection of sterile 0.9% sodium c...

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Temporal Trends in Gonococcal Antibiotic Resistance in Baltimore

Cited by 21 publications

References 0 publications

Antibacterial activities of OPC-17116, ofloxacin, and ciprofloxacin against 200 isolates of Neisseria gonorrhoeae

Antibacterial activities of OPC-17116, ofloxacin, and ciprofloxacin against 200 isolates of Neisseria gonorrhoeae

Temporal trends in gonococcal population genetics in a high prevalence urban community

Comparison of ciprofloxacin and ceftriaxone as single-dose therapy for uncomplicated gonorrhea in women

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