 |
 |
|
Rapid Responses to:
|
|
Electronic letters published:
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif){kind=icon}
Emerging Antimicrobial Resistance in Neisseria gonorrhoeae
|
|
|||
|
Takashi Deguchi, MD Department of Urology, Graduate School of Medicine, Gifu University, Mitsuru Yasuda, and Shin-Ichi Maeda
Send rapid response to journal:
deguchit{at}gifu-u.ac.jp Takashi Deguchi, et al.
|
Workowski and colleagues report the emerging antimicrobial resistance in Neisseria gonorrhoeae and the urgent need of an integrated, comprehensive approach to control gonorrhea (1). In particular, we agree with them in the importance of enhancement of national and international surveillance systems to monitor antimicrobial resistance. In Japan, nationwide surveillance of antimicrobial resistance of N. gonorrhoeae has not been conduced, and high priority has not been placed on funding for such surveillance. Antimicrobial resistance of N. gonorrhoeae has not been controlled in an efficient or timely manner to prolong the efficacy of existing antibiotics. As a consequence, effective oral regimens for treatment of gonorrhea have been lost. In Japan, treatment failures with fluoroquinolones were first reported in 1994. Since the late 1990s, there has been an increase in clinical strains with decreased susceptibility to fluoroquinolones (2). In 1999, fluoroquinolones were excluded from recommendations and guidelines for treatment of gonococcal infections. As alternatives to fluoroquinolones, oral cephalosporins were commonly used. Since 2001, however, a decrease in susceptibility of clinical strains to them has also been observed (2). Such strains have a mosaic penicillin-binding protein 2 (PBP 2) composed of fragments of PBP 2 from Neisseria cinerea and Neisseria perflava (3). This mosaic PBP 2 is significantly associated with decreased susceptibility to oral cephalosporins. The emergence and spread of such strains forced exclusion of cefixime from the 2006 recommendations and guidelines. In Japan, a single oral 1-g dose of azithromycin is used for treatment of non-gonococcal urethritis but is not registered for treatment of gonorrhea. However, decreased susceptibility of clinical strains to azithromycin has been observed (4). Higher doses of azithromycin are not and will not be recommended. No longer are there oral regimens for treatment of gonorrhea in Japan. For spectinomycin and ceftriaxone, resistance is rare. Strains with the mosaic PBP 2 are still sensitive to ceftriaxone. Ceftriaxone is also effective against gonococcal pharyngeal infection. In Japan, therefore, ceftriaxone is the only agent recommended as the first-choice treatment for gonococcal infections. In conclusion, global spread of N. gonorrhoeae strains against which oral regimens are not effective is a matter of serious concern, and emergence of N. gonorrhoeae strains with resistance to injectable agents is disastrous. As Workowski and colleagues describe (1), ideally, a coherent global surveillance system, which can generate the high-quality data on which decisions for treatment change are based, rather than regional surveillances in isolation, should be established before the disease becomes untreatable. Takashi Deguchi, MD and Mitsuru Yasuda, MD Graduate School of Medicine, Gifu University Gifu, Japan Shin-ichi Maeda, MD Toyota Memorial Hospital, Toyota, Japan. Potential Financial Conflicts of Interest: None disclosed. References 1. Workowski KA, Berman SM, Douglas JM. Emerging antimicrobial resistance in Neisseria gonorrhoeae: urgent need to strengthen prevention strategies. Ann Intern Med. 2008;148:606-13. [PMID: 18413622] 2. Ito M, Yasuda M, Yokoi S, Ito S-I, Takahashi Y, Ishihara S, et al. Remarkable increase in Central Japan in 2001-2002 of Neisseria gonorrhoeae isolates with decreased susceptibility to penicillin, tetracycline, oral cephalosporins, and fluoroquinolones. Antimicrob Agents Chemother. 2004;48:3185-7. [PMID: 15273147] 3. Ito M, Deguchi T, Mizutani K-S, Yasuda M, Yokoi S, Ito S-I, et al. Emergence and spread of Neisseria gonorrhoeae clinical isolates harboring mosaic-like structure of penicillin-binding protein 2 in central Japan. Antimicrob Agents Chemother. 2005;49:137-43. [PMID: 15616287] 4. Yasuda M, Hagiwara N, Ishihara S, Maeda S, Deguchi T. Remarkable increase of Neisseria gonorrhoeae with decreased susceptibility to cefixime and azithromycin. [Abstract]. Presented in the 46th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, California 27 September-30, 2006: Abstract L2-1230. Conflict of Interest:None declared |
|||
