Following continued declines in cefixime susceptibility, CDC updated its
recommendations in 2012 to recommend ceftriaxone plus either
azithromycin or doxycycline as the only first-line treatment.
CDC’s 2015 STD Treatment Guidelines now recommend only one regimen
of dual therapy for the treatment of gonorrhea—the injectable cephalosporin
ceftriaxone, plus oral azithromycin. Dual therapy is recommended to address
the potential emergence of gonococcal cephalosporin resistance.
In 2012 and 2013, there were dramatic decreases in resistance to cefixime.
However, resistance levels increased in 2014. CDC has not received any
reports of verified clinical treatment failures to any cephalosporin in the
United States.
Challenges
A major challenge to monitoring emerging antimicrobial resistance of N.
gonorrhoeae is the substantial decline in the use of gonorrhea culture by
many clinicians, as well as the reduced capability of many laboratories to
perform gonorrhea culture techniques required for antibiotic susceptibility
testing. Culture testing is when the bacteria is first grown on a nutrient plate
and is then exposed to known amounts of an antibiotic to determine the
bacteria’s susceptibility to the antibiotic. The decline in culture testing results
from an increased use of newer nonculture-based laboratory technology,
such as a diagnostic test called the Nucleic Acid Amplification Test
(NAAT). Currently, there is no well-studied reliable technology that allows
for antibiotic susceptibility testing from nonculture specimens. Increased
laboratory culture capacity is needed.
Laboratory Issues
CDC recommends that all state and local health department labs maintain or
develop the capacity to perform gonorrhea culture, or form partnerships with
experienced laboratories that can perform this type of testing.Centers for Disease Control. (2016). Antibiotic resistance solutions initiative. CDC.
http://www.cdc.gov/budget/documents/fy2016/antibiotic-resistance-factsheet.pdf
Centers for Disease Control. (2015c). Nearly half a million Americans suffered from
Clostridium difficile infections in a single year. CDC.
http://www.cdc.gov/media/releases/2015/p0225-clostridium-difficile.html
- “Clostridium difficile (C. difficile) caused almost half a million infections among
patients in the United States in a single year, according to a study released today