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Cefixime no longer recommended to treat gonorrhea

Thursday August 9, 2012
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The Centers for Disease Control and Prevention has announced that it no longer recommends the oral antibiotic cefixime as a first-line treatment option for gonorrhea in the United States.

The change was prompted by recent trends in laboratory data showing that cefixime, marketed under the brand name Suprax, is becoming less effective in treating gonorrhea, raising the possibility that Neisseria gonorrhoeae, which causes the disease, is becoming resistant to the drug.

The change leaves only one recommended drug, the injectable antibiotic ceftriaxone, that is proven effective for treating gonorrhea.

According to the revised guidelines, published in the Aug. 10 issue of the Morbidity and Mortality Weekly Report, the most effective treatment for gonorrhea is a combination therapy: ceftriaxone and one of two other oral antibiotics, either azithromycin or doxycycline.

In the past, gonorrhea has developed resistance to every antibiotic recommended for treatment, leaving the cephalosporins, which include cefixime and ceftriaxone, as the final recommended class of drugs. In light of this history and the recent lab data, CDC researchers are concerned that continued use of cefixime may prompt Neisseria gonorrhoeae to develop resistance to all cephalosporins. Limiting the use of cefixime may help preserve ceftriaxone as a treatment option for a little longer.

"As cefixime is losing its effectiveness as a treatment for gonorrhea infections, this change is a critical preemptive strike to preserve ceftriaxone, our last proven treatment option," Kevin Fenton, MD, director of the CDCís National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, said in a news release. "Changing how we treat infections now may buy the time needed to develop new treatment options."

To guard against the threat of drug resistance, the guidelines outline additional follow-up steps providers should take to closely monitor for ceftriaxone treatment failure. According to the new recommendations, patients who have persistent symptoms should be retested with a culture-based gonorrhea test, which can identify antibiotic-resistant infections. The patient should return one week after re-treatment for another culture test (a test-of-cure) to ensure the infection is fully cured.

In some instances, cefixime may be needed as an alternative treatment option. If ceftriaxone is not readily available, providers may prescribe a dual therapy of cefixime plus either azithromycin or doxycycline. Azithromycin may be given alone if a patient has a severe allergy to cephalosporins. However, to closely monitor for resistance, clinicians should perform a test-of-cure one week after treatment if either of these alternative regimens is prescribed.

Gail Bolan, MD, director of the CDCís Division of STD Prevention, said additional measures will be needed to stay ahead of untreatable gonorrhea. "It is imperative that researchers and pharmaceutical companies prioritize research to identify or develop new, effective drugs or drug combinations," Bolan said. "Health departments and labs can help CDC monitor for emerging resistance by enhancing or rebuilding their ability to do culture testing."

Individuals who are sexually active should take steps to protect themselves from infection, the CDC stated. Consistent and correct condom use and limiting the number of sex partners are effective strategies for reducing the risk of infection.

More than 700,000 gonorrhea infections are estimated to occur in U.S. each year, making it one of the most common STDs. Although some men and women may have symptoms such as burning when urinating or discharge, most people do not. As a result, many infections go undetected and untreated. Left untreated, gonorrhea can cause serious health problems, particularly for women, including chronic pelvic pain, life-threatening ectopic pregnancy and even infertility. Infection also increases the risk of contracting and transmitting HIV.

To read the full report and revised recommendations, visit http://1.usa.gov/NlL4W5.


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