Study raises concern over cefixime failure rate for gonorrhea

Researchers examining the effectiveness of cefixime in the treatment of gonorrhea found a relatively high treatment failure rate, raising concern that gonorrhea may become untreatable, according to results published January 9 in the Journal of the American Medical Association.

Lead author Vanessa G. Allen, MD, MPH, of Public Health Ontario in Toronto, Canada, and colleagues noted that cefixime is the only oral antimicrobial option recommended for treating the disease; however, increased minimum inhibitory concentrations (MICs) have been identified worldwide and have been associated with reports of clinical failure.

The researchers retrospectively examined records for 291 individuals with culture-positive Neisseria gonorrhoeae infections treated with cefixime between May 1, 2010 and April 30, 2011 at a single sexual health clinic in Toronto, Canada. Of 133 patients who returned for test of cure following treatment, 13 were culture positive for N. gonorrhoeae, nine of which were determined to have treatment failure-an overall rate clinical treatment failure rate of 6.77% (95% CI, 3.14%-12.45%).

“In light of the increases in cefixime MICs among isolates of N gonorrhoeae across North America, this study offers preliminary clinical data to support the recent CDC recommendations that cefixime is no longer optimal first-line therapy for the successful treatment of gonorrhea,” the authors wrote. “As elevated MICs to ceftriaxone are also emerging, albeit at 1 to 2 MIC dilutions less than the cefixime MIC, proactive strategies for the identification of clinical failures of N gonorrhoeae to this last commercially available agent are required.”