title: Trends of resistance to antimicrobials recommended currently and in the past for management of gonorrhea in the Apex STD center in India and comparison of antimicrobial resistance profile between 2002-2006 and 2007-2012.
abstract: BACKGROUND
  Antimicrobial resistance in Neisseria gonorrhoeae jeopardizes public health and continues to spread out to currently recommended and older antimicrobial agents. Antimicrobial resistance (AMR) surveillance provides essential clues toward the modification of treatment guidelines. The aim of the study was to determine gonococcal AMR profile and trends between 2007 and 2012 and to evaluate any change in AMR profile in comparison with published trends in 2002 to 2006.
  
  
  METHODS
  Antimicrobial susceptibility testing of 261 N. gonorrhoeae isolates from consecutive patients between 2007 and 2012 was determined for penicillin, tetracycline, ciprofloxacin, spectinomycin, extended-spectrum cephalosporins (ceftriaxone, cefixime, cefpodoxime) and azithromycin by the disk diffusion technique and the Etest method. P value was determined using χ test for comparisons of trends between the 2 periods.
  
  
  RESULTS
  In comparison of AMR trends between 2002-2006 and 2007-2012, penicillinase-producing N. gonorrhoeae, tetracycline-resistant N. gonorrhoeae, and ciprofloxacin-resistant strains increased significantly from 21.2% to 47.9% (P < 0.0001), 13.6% to 25.3% (P = 0.0002), and 78% to 89.7% (P = 0.0001), respectively. An insignificant increase from 2.4% to 4.2% (P > 0.05) in decreased susceptibility to ceftriaxone and 0.8% to 1.5% (P > 0.05) for azithromycin resistance was observed. All isolates were susceptible to spectinomycin over both the periods, except for one isolate in 2002.
  
  
  CONCLUSIONS
  The study highlights that there is a continuous increase in resistance to previously recommended antibiotics despite their disuse for treatment. The increase in number of strains with decreased susceptibility to extended-spectrum cephalosporins and azithromycin resistance, currently recommended for management of gonorrhea, is of serious concern. These trends should be monitored continuously to change antibiotic policy.
authors.affiliation: From the Apex Regional STD Teaching, Training & Research Centre, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India.
authors.forename: Manju
authors.initials: M
authors.lastname: Bala
authors.forename: Vikram
authors.initials: V
authors.lastname: Singh
authors.forename: Aradhana
authors.initials: A
authors.lastname: Bhargava
authors.forename: V
authors.initials: V
authors.lastname: Ramesh
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D017963:Azithromycin / Q000494:pharmacology; D002443:Ceftriaxone / Q000494:pharmacology; D002939:Ciprofloxacin / Q000494:pharmacology; D004352:Drug Resistance, Microbial / Q000187:drug effects*; D006069:Gonorrhea / Q000188:drug therapy* / Q000453:epidemiology; D006287:Health Planning Guidelines; D006801:Humans; D007194:India / Q000453:epidemiology; D008826:Microbial Sensitivity Tests / Q000379:methods*; D009344:Neisseria gonorrhoeae / Q000187:drug effects*; D018571:Sentinel Surveillance; D000198:Spectinomycin / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D002443:Ceftriaxone; D017963:Azithromycin; D000198:Spectinomycin