title: Optimizing treatment of antimicrobial-resistant Neisseria gonorrhoeae.
abstract: The increasing prevalence of ciprofloxacin-resistant Neisseria gonorrhoeae has required replacing inexpensive oral ciprofloxacin treatment with more expensive injectable ceftriaxone. Further, monitoring antimicrobial resistance requires culture testing, but nonculture gonorrhea tests are rapidly replacing culture. Since the strategies were similar in effectiveness (> 99%), we evaluated, from the healthcare system perspective, cost-minimizing strategies for both diagnosis (culture followed by antimicrobial susceptibility tests versus nonculture-based tests) and treatment (ciprofloxacin versus ceftriaxone) of gonorrhea in women. Our results indicate that switching from ciprofloxacin to ceftriaxone is cost-minimizing (i.e., optimal) when the prevalence of gonorrhea is > 3% and prevalence of ciprofloxacin resistance is > 5%. Similarly, culture-based testing and susceptibility surveillance are optimal when the prevalence of gonorrhea is < 13%; nonculture-based testing is optimal (cost-minimizing) when gonorrhea prevalence is > or = 13%.
authors.affiliation: Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. kjr3@cdc.gov
authors.forename: Kakoli
authors.initials: K
authors.lastname: Roy
authors.forename: Susan A
authors.initials: SA
authors.lastname: Wang
authors.forename: Martin I
authors.initials: MI
authors.lastname: Meltzer
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D015373:Bacterial Typing Techniques; D002443:Ceftriaxone / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D024881:Drug Resistance, Bacterial; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009010:Monte Carlo Method; D009344:Neisseria gonorrhoeae / Q000254:growth & development*
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D002443:Ceftriaxone