Neisseria gonorrhoeae Treatment Failure andSusceptibilitytoCefiximeinToronto,Canada

BECAUSE OF NEISSERIA GONORrhoeae resistance to all prior first-line antimicrobial agents, cephalosporin therapy with adjuvant azithromycin or doxycycline is recommended for treatment of gonorrhea. Cefixime is the only oral cephalosporin recommended for gonorrhea treatment, critical to the success of expedited partner therapy. An increase in the minimum inhibitory concentration (MIC) of N gonorrhoeae to cefixime, and to a lesser extent, an intramuscularly administered cephalosporin, ceftriaxone, has been identified in cultured isolates worldwide. The World Health Organization has sounded alarms for the threat of untreatable gonorrhea. The US Centers for Disease Control and Prevention (CDC) recently revised recommendations for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea. Ceftriaxone, 250 mg, intramuscularly combined with either azithromycin, 1 g, orally or doxycycline, 100 mg, orally twice a day for 7 days is the sole preferred treatment regimen, with oral cephalosporins no longer recommended as front-line therapy. If cefixime is used as an alternative therapy for gonorrhea, it is to be followed with a test of cure in 1 week. Use of cefixime See also p 185 and Patient Page. Author Affiliations: Public Health Ontario, Toronto, Canada (Drs Allen, Rebbapragada, Lee, and Melano and Mss Seah, Siebert, and Towns); Department of Laboratory Medicine and Pathobiology (Drs Allen, Rebbapragada, Melano, and Low) and Dalla Lana School of Public Health (Dr Lee), University of Toronto, Toronto; Hassle Free Clinic, Toronto (Mr Mitterni); National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada (Ms Martin); and Mount Sinai Hospital, Toronto, Canada (Dr Low). Corresponding Author: Vanessa G. Allen, MD, MPH, Public Health Ontario Laboratories, 81 Resources Rd, Toronto, ON M9P 3T1, Canada (vanessa.allen @oahpp.ca). Importance Although cephalosporins are the cornerstone of treatment of Neisseria gonorrhoeae infections, cefixime is the only oral antimicrobial option. Increased minimum inhibitory concentrations (MICs) to cefixime have been identified worldwide and have been associated with reports of clinical failure.