Penicillin resistant Neisseria gonorrhoeae in low prevalence areas: implications for cost-effective management

Though ampicillin is no longer recommended as first-line therapy for infections caused by Neisseria gonorrhoeae, the cost and efficacy of this policy in low prevalence areas has not been investigated. The problem was highlighted by an outbreak of penicillin-resistant N. gonorrhoeae in an area where the proportion of resistance had previously been only 0.14%. A decision analysis was performed to determine the cost-effectiveness of beta-lactamase screening and alternative therapies for patients attending sexually transmitted diseases clinics. Empiric therapy with an inexpensive agent active against resistant strains, such as ciprofloxacin, was the most cost-effective approach and remained more cost-effective than alternative strategies whenever the proportion of resistant isolates exceeded 3%. Ceftriaxone was less cost-effective. In low prevalence areas, and in areas where the return rate of recalled patients is high, ampicillin therapy was cost-effective, but beta-lactamase screening should be performed routinely.