The JAID/JSC guidelines to Clinical Management of Infectious Disease 2017 concerning male urethritis and related disorders

Hamasuna, Ryoichi; Yasuda, Mitsuru; Takahashi, Satoshi; Uehara, Shuichiro; Kawai, Yasuhiro; Miyairi, Isao; Arakawa, Soichi; Kiyota, Hiroshi; Guide, Jsc

doi:10.1016/j.jiac.2019.12.001

Cited by 11 publications

(2 citation statements)

References 98 publications

(80 reference statements)

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“…Although high-dose ceftriaxone is strongly recommended for the treatment of gonorrhea because of its reduced susceptibility, the evidence available from clinical studies is still limited. British Association for Sexual Health and HIV (BASHH) in the United Kingdom [ 19 ], China [ 20 , 21 ], and Japan [ 22 ] recommended that ceftriaxone should be administrated by both IM and IV routes for uncomplicated N. gonorrhoeae infections of the urethra, cervix, rectum, and pharynx in adults and youth. A clinical study in Japan evaluating the effectiveness of 1 g of ceftriaxone demonstrated a cure rate of 100% in 48 patients with urethral infection or cervical gonococcal infection including infection with strains with chimera penicillin binding protein 2 (PBP-2) expression that are resistant to oral cephalosporins [ 15 ] A systematic review and meta-analysis of clinical trials that investigated the efficacy of 800 mg of PO cefixime for the treatment of gonorrhea of the urethra, cervix, or rectum reported a cure rate of 98.0% [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trial of the relative efficacy of high-dose intravenous ceftriaxone and oral cefixime combined with doxycycline for the treatment of Chlamydia trachomatis and Neisseria gonorrhoeae co-infection

et al. 2022

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Objectives Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the commonest bacterial causes of sexually transmitted infections in humans with high incidence of co-infection. Treatment with high doses of ceftriaxone (CRO) and cefixime (CFM) is strongly recommended due to the reduced drug susceptibility of NG. However, their safety and efficacy have not been confirmed. We compared the safety and efficacy of a single 1 g intravenous (IV) dose of ceftriaxone (CRO) plus doxycycline (DOX) versus a single 800 mg oral dose of cefixime (CFM) plus DOX for the treatment of NG-CT co-infection. Methods An open-label randomized controlled trial was conducted on 125 individuals aged > 18 years with untreated gonorrhea and chlamydia to compare a single 1 g intravenous dose of CRO + DOX and a single 800 mg oral dose of CFM + DOX. The primary outcome was the clearance of NG from all the initially infected sites. Secondary outcomes included symptom resolution, changes in the serum clearance levels, glomerular filtration rate, and antibiotic minimum inhibitory concentrations. Results Both regimens were highly effective in treating gonorrhea with success rates of 96.7% (95% confidence interval [CI] 88.8–99.1%) for CRO and 95.3% (95% CI 87.1–98.4%) for CFM. However, CRO + DOX was superior to CFM + DOX for the treatment of NG-CT co-infection (odds ratio 4.41, 95% CI 1.11–25.7). The safety profiles of the two regimens were similar. Conclusions CRO + DOX was superior to CFM + DOX for the treatment of NG-CT co-infection. CFM + DOX may be indicated in patients with CRO allergy and in settings where CRO is unavailable. Trial registration ClinicalTrials.gov (NCT05216744) on 31/01/22.

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Section: Discussionmentioning

confidence: 99%

Randomized controlled trial of the relative efficacy of high-dose intravenous ceftriaxone and oral cefixime combined with doxycycline for the treatment of Chlamydia trachomatis and Neisseria gonorrhoeae co-infection

et al. 2022

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“…Sitafloxacin, known for its broad antibacterial spectrum, emerges as a promising treatment alternative. As of 2017, sitafloxacin has been recommended in Japan as a primary treatment for chlamydial urethritis and a secondary option for non-chlamydial, non-gonococcal urethritis [18]. Moreover, since 2019, China has approved sitafloxacin for treating urinary tract infections and pneumonia when caused by susceptible strains [19].…”

Section: Discussionmentioning

confidence: 99%

Emergence of Neisseria gonorrhoeae Clone with Reduced Susceptibility to Sitafloxacin in China: An In Vitro and Genomic Study

Ye,

Yao,

et al. 2024

Antibiotics

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Drug-resistant Neisseria gonorrhoeae poses an urgent threat to public health. Recently, sitafloxacin, a new-generation fluoroquinolone, has shown high in vitro activity against drug-resistant N. gonorrhoeae. However, data on its effectiveness in clinical isolates remains limited. In this study, we collected 507 N. gonorrhoeae isolates from 21 hospitals in Shanghai, China, during 2020 and 2021. Antimicrobial susceptibility testing revealed that sitafloxacin minimum inhibitory concentrations (MICs) exhibited a bimodal distribution, ranging from <0.004 to 2 mg/L. The MIC50 and MIC90 for sitafloxacin were 0.125 mg/L and 0.5 mg/L, respectively, which are 32 and 16 times lower than those for ciprofloxacin (4 mg/L and 8 mg/L, respectively). Sitafloxacin demonstrated high in vitro activity against isolates resistant to either ceftriaxone, azithromycin, or both. Notably, among the isolates with reduced sitafloxacin susceptibility (MIC ≥ MIC90), 83.7% (36/43) were identified as sequence type (ST) 8123. Further phylogenetic analysis showed that ST8123 has evolved into two subclades, designated as subclade-I and subclade-II. A majority of the isolates (80%, 36/45) within subclade-I exhibited reduced susceptibility to sitafloxacin. In contrast, all isolates from subclade-II were found to be susceptible to sitafloxacin. Subsequent genomic investigations revealed that the GyrA-S91F, D95Y, and ParC-S87N mutations, which were exclusively found in ST8123 subclade-I, might be linked to reduced sitafloxacin susceptibility. Our study reveals that sitafloxacin is a promising antibiotic for combating drug-resistant N. gonorrhoeae. However, caution is advised in the clinical application of sitafloxacin for treating N. gonorrhoeae infections due to the emergence of a clone exhibiting reduced susceptibility.

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The third nationwide surveillance of antimicrobial susceptibility against Neisseria gonorrhoeae from male urethritis in Japan, 2016–2017

Yasuda,

Takahashi,

Miyazaki

et al. 2023

Journal of Infection and Chemotherapy

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The JAID/JSC guidelines to Clinical Management of Infectious Disease 2017 concerning male urethritis and related disorders

Cited by 11 publications

References 98 publications

Randomized controlled trial of the relative efficacy of high-dose intravenous ceftriaxone and oral cefixime combined with doxycycline for the treatment of Chlamydia trachomatis and Neisseria gonorrhoeae co-infection

Randomized controlled trial of the relative efficacy of high-dose intravenous ceftriaxone and oral cefixime combined with doxycycline for the treatment of Chlamydia trachomatis and Neisseria gonorrhoeae co-infection

Emergence of Neisseria gonorrhoeae Clone with Reduced Susceptibility to Sitafloxacin in China: An In Vitro and Genomic Study

The third nationwide surveillance of antimicrobial susceptibility against Neisseria gonorrhoeae from male urethritis in Japan, 2016–2017

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