title: Emergence and spread of drug resistant Neisseria gonorrhoeae.
abstract: OBJECTIVE
  The emergence and spread of Neisseria gonorrhoeae with resistance to oral antibiotics have led to difficulty in treating gonorrhea. We review drug resistance in N. gonorrhoeae with a particular emphasis on resistance to fluoroquinolones, cefixime and azithromycin.
  
  
  METHODS
  Literature selected from peer reviewed journals listed in MEDLINE(R)/PubMed(R) from 1943 to 2009 and from resources cited in those articles was reviewed comprehensively.
  
  
  RESULTS
  Due to the spread of fluoroquinolone resistant N. gonorrhoeae fluoroquinolones are no longer recommended for the treatment of gonorrhea. The emergence of N. gonorrhoeae with a mosaic penicillin-binding protein 2 associated with oral cephalosporin resistance has threatened cefixime treatment for gonorrhea. Emergence of N. gonorrhoeae with high level resistance to azithromycin has also been documented. However, injectable antibiotics (sepctinomycin and ceftriaxone) retain their activity against N. gonorrhoeae. To monitor drug resistance in N. gonorrhoeae several national and international programs have become functional.
  
  
  CONCLUSIONS
  Oral regimens for the treatment of gonorrhea are limited. At present to our knowledge ceftriaxone is the most reliable and available agent for the treatment of gonorrhea. To prevent the further emergence and international spread of drug resistance, and allow for the selection of appropriate treatments, a comprehensive global program is needed including surveillance for drug resistance in N. gonorrhoeae and collection of patient epidemiological data. Clinicians should effectively treat patients with gonorrhea, always being conscious of local trends of drug resistance in N. gonorrhoeae, and should perform culture and antimicrobial susceptibility testing in those with persistent gonorrhea after treatment.
authors.affiliation: Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan. deguchit@gifu-u.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Deguchi
authors.forename: Keita
authors.initials: K
authors.lastname: Nakane
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Yasuda
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Maeda
mesh_terms: D017963:Azithromycin / Q000494:pharmacology*; D020682:Cefixime / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D024841:Fluoroquinolones / Q000494:pharmacology*; D006069:Gonorrhea / Q000188:drug therapy; D006801:Humans; D009344:Neisseria gonorrhoeae / Q000187:drug effects*; D011159:Population Surveillance; D014526:Urethritis / Q000188:drug therapy / Q000382:microbiology
chemical_list: D024841:Fluoroquinolones; D017963:Azithromycin; D020682:Cefixime