Antimicrobial susceptibility of Neisseria gonorrhoeae in Cuba (1995-1999): implications for treatment of gonorrhea.
BACKGROUND
Antibiotic-resistant strains of Neisseria gonorrhoeae, especially those resistant to penicillin and tetracycline, have spread with remarkable rapidity in many Caribbean countries.


OBJECTIVE
The goal of the study was to survey the antibiotic susceptibilities of N gonorrhoeae strains isolated from 1995 to 1999 in Cuba and to discuss the impact of antimicrobial resistance on the management of gonorrhea in the country.


METHODS
Susceptibility of the strains to penicillin, tetracycline, cefuroxime, ceftriaxone, ciprofloxacin, spectinomycin, and azithromycin were determined by an agar dilution method.


RESULTS
Penicillin and tetracycline resistance was noted in 60.8% and 54.2%, respectively, of the N gonorrhoeae strains tested. A total of 63.35 (76/120) of the N gonorrhoeae strains exhibited plasmid-mediated resistance to penicillin, tetracycline, or both. Strains with chromosomally mediated resistance to these antibiotics accounted for 10% (12/120) of the strains. The strains were susceptible to ceftriaxone, cefuroxime, spectinomycin, and ciprofloxacin. One strain's ciprofloxacin MIC was 0.125 mircog/ml. Of the 52 strains tested, 23.1% displayed intermediate resistance to azithromycin.


CONCLUSIONS
N gonorrhoeae strains exhibited a high frequency of resistance and multiresistance to penicillin and tetracycline. Therefore, these antibiotics should no longer be used to treat gonococcal infections in Cuba and should be substituted with effective drugs such as third-generation cephalosporins, spectinomycin, and fluoroquinolones. The detection of intermediate resistance to azithromycin and ciprofloxacin underlines the importance of periodic surveillance for susceptibility of N gonorrhoeae strains to antimicrobials agents used as primary therapy for gonorrhea.
Llanes
Rafael
R
Microbiology Branch, Tropical Medicine Institute Pedro Kourí, Havana, Cuba. llanesrafael2002@yahoo.com
Sosa
Jorge
J
Guzmán
Daymi
D
Llop
Alina
A
Valdés
Eduardo A
EA
Martínez
Isabel
I
Palma
Sara
S
Lantero
María I
MI
D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D003462:Cuba / Q000453:epidemiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology* / Q000382:microbiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000302:isolation & purification; D010403:Penicillin Resistance; D010406:Penicillins / Q000494:pharmacology; D013752:Tetracycline / Q000494:pharmacology; D013753:Tetracycline Resistance
D000900:Anti-Bacterial Agents; D010406:Penicillins; D013752:Tetracycline