Fluoroquinolone-resistant Neisseria gonorrhoeae: the inevitable epidemic.
The worldwide incidence of fluoroquinolone-resistant Neisseria gonorrhoeae has increased dramatically in the last few years. Single doses of fluoroquinolones can no longer be used to treat N gonorrhoeae infections acquired in the Far East, parts of the Middle East, the Pacific Islands, and parts of Western Europe and the United States. Although California and Hawaii account for most of the current United States cases, the increased incidence of FQR in some high-risk groups independent of geography heralds an imminent spread of drug-resistant strains throughout the rest of the population. The use of molecular tests has revolutionized the diagnostic field in STIs. The main limitation of their application in N gonorrhoeae testing has been the loss of culture specimens that allow antimicrobial sensitivity testing. New molecular methods have made it possible to detect antimicrobial resistance without the use of live organisms. These tests hold the promise of improving epidemiologic tracking of N gonorrhoeae drug resistance, leading to better patient management at the local level. The loss of fluoroquinolones limits available oral regimens to a single CDC-recommended antibiotic, cefixime. Oral, inexpensive, single-dose alternatives are needed to ensure continued therapeutic success.
Ghanem
Khalil G
KG
Division of Infectious Diseases, Johns Hopkins University, Bayview Medical Center, 4940 Eastern Avenue, B3 North, Suite 352, Baltimore, MD 21224, USA. kghanem@jhmi.edu
Giles
Julie A
JA
Zenilman
Jonathan M
JM
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000075202:Contraindications; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006069:Gonorrhea / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009154:Mutation; D009344:Neisseria gonorrhoeae / Q000187:drug effects / Q000235:genetics* / Q000472:pathogenicity
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones