The use of cephalosporins for gonorrhea: an update on the rising problem of resistance.
BACKGROUND
Over the last several years, Neisseria gonorrhoeae has developed decreased susceptibility to extended-spectrum cephalosporins worldwide. Gonococcal antimicrobial surveillance programs in multiple regions have documented the rise in N. gonorrhoeae isolates' minimum inhibitory concentrations to cephalosporins, and the first cases of ceftriaxone treatment failure have been reported. These developments have prompted the use of the term 'superbug' and concerns about the emergence of untreatable gonococcal infections.


METHODS
Since the publication of the last detailed review of the use of cephalosporins for gonorrhea in 2009, several new developments have occurred, which are detailed in this review. A variety of treatment strategies have been proposed in response to this 'superbug' threat, including increasing the dose or providing multiple doses of cephalosporins, multidrug therapy, rotating therapeutic regimens and individualized treatment based on susceptibility testing.


CONCLUSIONS
A robust public health response is needed that includes better diagnosis and treatment of pharyngeal gonorrhea, improved surveillance of antimicrobial resistance, informed treatment approaches and reduction of the global burden of gonococcal infections.
San Francisco Department of Public Health STD Prevention and Control Services, University of California-San Francisco, Division of Infectious Diseases, 513 Parnassus Avenue, Box 0654, San Francisco, CA 94143, USA. juliet.stoltey@ucsf.edu
Juliet E
JE
Stoltey
Pennan M
PM
Barry
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D006069:Gonorrhea / Q000188:drug therapy*; D006801:Humans; D011159:Population Surveillance
D000900:Anti-Bacterial Agents; D002511:Cephalosporins