Cephalosporin resistant Neisseria gonorrhoeae: time to consider gentamicin?

For penicillin, this process took a number of decades but with the subsequent use of tetracyclines, macrolides and fluoroquinolones, the cycle has shortened, and the utility of oral cephalosporins is now threatened within a few short years of their introduction as preferred therapy in many countries. 1 Following the emergence of N gonorrhoeae strains with decreased susceptibility to oral cephalosporins, clinical treatment failures soon appeared in Japan and Hong Kong; 2-4 more recently, similar outcomes have reported from other regions of the world, including Europe. The latter is important as those strains with decreased susceptibility to oral cephalosporins also have high MICs to penicillins, tetracyclines and macrolides. 2 Gonococci tend to retain resistance phenotypes and genotypes to those antibiotics used earlier for treatment, even when their use has been discontinued, which generally rules out reintroducing them in the current era of multidrug-resistant gonorrhoea. 6 It is, therefore, not too surprising to note that the majority of circulating gonococcal strains with decreased susceptibility to oral cephalosporins are also resistant to fluoroquinolones. 2 The world's first extensively drug-resistant N gonorrhoeae strain (H041), defined by criteria put forward by Tapsall et al, was recently described in detail. 6 7 This H041 strain has a ceftriaxone MIC of 2-4 mg/l, which is fourfold to eightfold higher than previously reported, as well as a cefixime MIC of 8 mg/l.