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Which cephalosporin for gonorrhoea?
C A Ison1, J W Mouton, K Jones
1Sexually Transmitted Bacteria Reference Laboratory, Specialist and Reference Microbiology Division, Health Protection Agency, 61 Colindale Avenue, London NW9 5HT, UK. catherine.ison@hpa.org.uk
Sexually Transmitted Infections
|October 2, 2004
Summary
Ciprofloxacin resistance in gonorrhoea treatment is rising. Ceftriaxone or cefixime are recommended alternatives, as cefuroxime regimens show borderline efficacy and risk increased resistance.
Area of Science:
- Pharmacology
- Microbiology
- Public Health
Background:
- Ciprofloxacin was a common gonorrhoea treatment in the UK.
- Rising resistance to ciprofloxacin (9.8% in 2002) made it less effective.
- Newer guidelines recommend third-generation cephalosporins like ceftriaxone and cefixime.
Purpose of the Study:
- To compare the pharmacodynamic potency of recommended and alternative cephalosporin regimens for gonorrhoea.
- To assess if current cefuroxime use for gonorrhoea is pharmacodynamically adequate.
- To inform optimal antibiotic selection for gonorrhoea treatment.
Main Methods:
- Pharmacodynamic analysis of antibiotic regimens.
- Calculation of free drug concentrations above the Minimum Inhibitory Concentration (MIC90).
- Comparison of achieved drug exposure durations for different cephalosporins.
Main Results:
- Ceftriaxone (intramuscular) and cefixime (oral) provided adequate drug concentrations for 22-50 hours.
- Current cefuroxime regimens (oral or intramuscular) were pharmacodynamically borderline, achieving target concentrations for only 6.8-11.2 hours.
- This suggests cefuroxime may not be sufficiently potent for effective gonorrhoea treatment.
Conclusions:
- Ceftriaxone and cefixime are the preferred agents to replace ciprofloxacin for gonorrhoea.
- Cefuroxime is a suboptimal choice due to borderline pharmacodynamics.
- Continued use of cefuroxime may lead to increased gonococcal resistance.