A Randomized Trial of Ciprofloxacin versus Cefixime for Treatment of Gonorrhea after Rapid Emergence of Gonococcal Ciprofloxacin Resistance in The Philippines

• Published in: Clinical infectious diseases Vol. 32; no. 9; pp. 1313 - 1318
• Main Authors: Aplasca de los Reyes, Mari Rose, Pato-Mesola, Virginia, Klausner, Jeffrey D., Manalastas, Ricardo, Wi, Teodora, Tuazon, Carmelita U., Dallabetta, Gina, Whittington, W. L. H., Holmes, King K.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01-05-2001; University of Chicago Press
• Subjects: Adolescent; Adult; AIDS; Anti-Infective Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Cefixime - therapeutic use; Cephalosporins - therapeutic use; Ciprofloxacin - therapeutic use; Dosage; Drug Resistance, Microbial; Female; Fluoroquinolones; Genetic mutation; Gonorrhea; Gonorrhea - drug therapy; Gonorrhea - epidemiology; Gonorrhea - microbiology; Humans; Infections; Major Articles; Medical sciences; Medical treatment failures; Neisseria gonorrhoeae; Neisseria gonorrhoeae - drug effects; Neisseria gonorrhoeae - isolation & purification; Pharmacology. Drug treatments; Philippines - epidemiology; Pretreatment; Prospective Studies; Sex Work; Sex workers; Treatment Outcome; Tropical medicine; Asia; Philippine Islands; Drug susceptibility test; Neisseriaceae; Genital diseases; Prostitution; Fluoroquinolone derivatives; Gonococcal infection; Bacteria; Micrococcales; Cefixime; Woman; Quinolone derivatives; Human; β-Lactams; Oral administration; Female genital diseases; Infection; Resistance; Antibiotic; Chemotherapy; Cephalosporin derivatives; Sexually transmitted disease; Neisseria gonorrhoeae; Treatment; Minimum inhibitory concentration; Bacteriosis; Antibacterial agent; Ciprofloxacin; Comparative study
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/319998

From 1994 through 1996–1997, high-level ciprofloxacin resistance (minimum inhibitory concentration [MIC], ⩾4.0 µg/mL) increased from 9% to 49% of gonococcal isolates recovered from consecutive female sex workers in Cebu and Manila, The Philippines (P < .01). During 1996–1997, 105 female sex workers with gonorrhea were prospectively randomized to receive treatment with oral ciprofloxacin, 500 mg, or cefixime, 400 mg, and followed for test of cure. Neisseria gonorrhoeae was reisolated within 28 days after treatment from 1 (3.8%) of 26 women given cefixime versus 24 (32.3%) of 72 women given ciprofloxacin (P < .01). Treatment failure (reisolation of pretreatment auxotype/serovar) occurred in 14 (46.7%) of 30 women infected with strains with MICs of ciprofloxacin ⩾4.0 µg/mL versus 1 (3.6%) of 28 infected by strains with MICs <4.0 µg/mL (P < .01). High-level, clinically significant gonococcal resistance to ciprofloxacin has rapidly emerged in The Philippines, and spread of fluoroquinolone resistance through commercial sex poses a threat to control of gonorrhea and prevention of human immunodeficiency virus infection and the acquired immunodeficiency syndrome.