CDC: Don't Use Fluoroquinolones for Gonococcal Infections

CDC officials recently announced that an entire class of antibiotics -- the fluoroquinolones -- is no longer recommended for treatment of gonococcal infections and associated conditions, such as pelvic inflammatory disease. The CDC announcement means that only one class of antibiotics remains to treat these infections.

According to data published in the April 13 Morbidity and Mortality Weekly Report, the prevalence of fluoroquinolone-resistant Neisseria gonorrhoeae, or QRNG, in the United States has risen steadily during the past decade, following years of the CDC recommending oral fluoroquinolones as a first-line treatment for gonorrhea and related infections. Those data were gathered as part of the CDC's Gonococcal Isolate Surveillance Project, or GISP.

GISP, which has monitored antimicrobial susceptibilities in N. gonorrhoeae since 1986, collects thousands of urethral gonococcal isolates each year from men presenting at sexually transmitted disease clinics across the country and then provides national data used to guide treatment of gonococcal infections. The most recent GISP findings show that QRNG is becoming widespread in the United States, mandating new treatment regimens against these infections.

Recommended treatment options for infections caused by N. gonorrhoeae now are limited to cephalosporins. Within this drug class, the CDC recommends use of ceftriaxone, available only as an injection, as a first-line treatment for all types of gonorrhea -- anal, genital and pharyngeal. The oral cephalosporin recommended for initial treatment, cefixime, has only limited availability in the United States.

Complete updated treatment recommendations, including recommended therapy for patients unable to tolerate cephalosporins, appear on the CDC Web site.

It's worth noting that those recommendations state, "Fluoroquinolones may be an alternative treatment option if antimicrobial susceptibility can be documented by culture. With use of nonculture tests to diagnose N. gonorrhoeae increasing and with local data on antimicrobial susceptibility less available, laboratories should maintain the capacity to conduct such testing or form partnerships with laboratories that can."

Visit the CDC's Sexually Transmitted Disease Treatment Guidelines page for more on the announcement, including a "Dear Colleague Letter." In the letter, John Douglas Jr., M.D., director of the Division of STD Prevention at CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, calls for health professionals to collaborate in tracking antimicrobial resistance.

"Specifically," Douglas' letter notes, "CDC strongly encourages state and local health departments to