Document Detail


Neisseria gonorrhoeae treatment failure and susceptibility to cefixime in Toronto, Canada.
MedLine Citation:
PMID:  23299608     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
IMPORTANCE: Although cephalosporins are the cornerstone of treatment of Neisseria gonorrhoeae infections, cefixime is the only oral antimicrobial option. Increased minimum inhibitory concentrations (MICs) to cefixime have been identified worldwide and have been associated with reports of clinical failure.
OBJECTIVE: To assess the risk of clinical treatment failure of N. gonorrhoeae infections associated with the use of cefixime.
DESIGN, SETTING, AND POPULATION: A retrospective cohort study of culture-positive N. gonorrhoeae infections at a single sexual health clinic in Toronto, Canada, that routinely performs test of cure. The cohort comprised N. gonorrhoeae culture-positive individuals identified between May 1, 2010, and April 30, 2011, treated with cefixime as recommended by Public Health Agency of Canada guidelines.
MAIN OUTCOME MEASURES: Cefixime treatment failure, defined as the repeat isolation of N. gonorrhoeae at the test-of-cure visit identical to the pretreatment isolate by molecular typing and explicit denial of reexposure.
RESULTS: There were 291 N. gonorrhoeae culture-positive individuals identified. Of 133 who returned for test of cure, 13 were culture positive; 9 patients were determined to have experienced cefixime treatment failure, involving urethral (n = 4), pharyngeal (n = 2), and rectal (n = 3) sites. The overall rate of clinical treatment failure among those who had a test of cure was 6.77% (95% CI, 3.14%-12.45%; 9/133). The rate of clinical failure associated with a cefixime MIC of 0.12 μg/mL or greater was 25.0% (95% CI, 10.69%-44.87%; 7/28) compared with 1.90% (95% CI, 0.23%-6.71%; 2/105) of infections with cefixime MICs less than 0.12 μg/mL, with a relative risk of 13.13 (95% CI, 2.88-59.72; P < .001).
CONCLUSION AND RELEVANCE: The rate of clinical failure following treatment of N. gonorrhoeae infections with cefixime was relatively high at a Toronto clinic and was associated with elevated MICs.
Authors:
Vanessa G Allen; Leo Mitterni; Christine Seah; Anuradha Rebbapragada; Irene E Martin; Colin Lee; Heather Siebert; Lynn Towns; Roberto G Melano; Donald E Low
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JAMA : the journal of the American Medical Association     Volume:  309     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-09     Completed Date:  2013-01-10     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  163-70     Citation Subset:  AIM; IM    
Affiliation:
Public Health Ontario Laboratories, 81 Resources Rd, Toronto, ON M9P 3T1, Canada. vanessa.allen@oahpp.ca
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MeSH Terms
Descriptor/Qualifier:
Adult
Anti-Bacterial Agents / pharmacology*,  therapeutic use
Cefixime / pharmacology*,  therapeutic use
Cohort Studies
Drug Resistance, Microbial
Female
Gonorrhea / drug therapy*
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Neisseria gonorrhoeae / drug effects,  isolation & purification*
Ontario
Retrospective Studies
Risk
Treatment Failure
Young Adult
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 79350-37-1/Cefixime
Comments/Corrections
Comment In:
JAMA. 2013 May 15;309(19):1989   [PMID:  23677303 ]
JAMA. 2013 May 15;309(19):1989-90   [PMID:  23677304 ]
JAMA. 2013 Jan 9;309(2):185-7   [PMID:  23299612 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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