Two cases of verified clinical failures using internationally recommended first-line cefixime for gonorrhoea treatment, Norway, 2010

Abstract

Neisseria gonorrhoeae has developed resistance to most of the available therapeutic antimicrobials. The susceptibility to extended-spectrum cephalosporins, the last remaining first-line treatment option, is decreasing globally. This report describes the first two cases outside Japan of verified gonorrhoea clinical failures using internationally recommended firstline cefixime treatment. Enhanced awareness and more frequent follow-up examination, test-of-cure and appropriate verification/falsification of presumed clinical treatment failures, involving several clinical and laboratory parameters should be strongly emphasised worldwide.

2012 European guideline on the diagnosis and treatment of gonorrhoea in adults

“…42,[44][45][46][47]49 Cefixime is only an alternative option if administration of an intramuscular injection is not possible or refused by the patient. However, caution should be taken using cefixime 400 mg only, particularly for treatment of pharyngeal infection, and ideally, if used, it should always be given together with azithromycin 2 g as a single oral dose (see alternative regimen 1 above).…”

Evaluation of Neisseria gonorrhoeae Multiple-Locus Variable-Number Tandem-Repeat Analysis, N. gonorrhoeae Multiantigen Sequence Typing, and Full-Length porB Gene Sequence Analysis for Molecular Epidemiological Typing

“…To challenge the stability of the genotyping methods, we also examined a panel that consisted of three different strains from three divergent verified sexual transmission chains (in total six isolates from six patients) and the pre-and posttreatment isolates from three cases of treatment failures using extended-spectrum cephalosporins (in total six isolates) (23,24). Finally, the 2008 WHO N. gonorrhoeae reference strains were included as quality controls (22).…”

Modern aspects of epidemiological surveillance of gonococcal infection spread

“…Отмечено, что среди мужчин про-цент штаммов со сниженными показателями чув-ствительности к цефиксиму и цефродоксину выше, чем в популяциях с необозначенной гендерной при-надлежностью или у женщин [39,[66][67][68][69][70]. Отмечен высокий риск появления штаммов N. gonorrhoeae, не чувствительных к цефиксиму и цефродоксину, сре-ди МСМ [71].…”