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Genitourin Med. 1996 Aug;72(4):253-7.

Antimicrobial agents and gonorrhoea: therapeutic choice, resistance and susceptibility testing.

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1
Department of Medical Microbiology, Imperial College School of Medicine at St Mary's, Paddington, London, UK.

Abstract

INTRODUCTION:

Neisseria gonorrhoeae, the causative agent of gonorrhoea is a particularly well adapted pathogen that has continued to evolve mechanisms to evade treatment with antimicrobial agents.

THERAPEUTIC CHOICE:

The choice of antibiotic for use in the first-line treatment of gonorrhoea should be made with knowledge of the susceptibility of the isolates of N gonorrhoeae to be encountered.

RESISTANCE:

High-level resistance to penicillin and tetracycline in N gonorrhoeae is plasmid-mediated and a major therapeutic problem. Penicillinase-producing N gonorrhoeae, first described in 1976, have now spread worldwide and tetracycline-resistant N gonorrhoeae, described in 1985, are becoming increasingly prevalent. Chromosomal resistance to penicillin is low-level and affects a range of antibiotics. High-level resistance to spectinomycin has been sporadic and has not limited its use whereas the emergence of resistance to ciprofloxacin will have a significant impact on its use for gonorrhoea.

SUSCEPTIBILITY TESTING:

A variety of methods are available including disc diffusion, breakpoint agar dilution technique, E-test and determination of the minimum inhibitory concentration (MIC). The choice of methodology will depend on the number and type of isolates and the facilities available for testing.

DISCUSSION:

Surveillance programmes to monitor levels of antibiotic resistant isolates are essential to ensure therapeutic success.

Comment in

PMID:
8976828
PMCID:
PMC1195672
[Indexed for MEDLINE]
Free PMC Article
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