According to study published in PLOS Medcine, Neisseria gonorrhoeae (N. gonorrhoeae) strains resistant to azithromycin and/or with decreased susceptibility to ceftriaxone are becoming more rampant in China.
The study, conducted by Yueping Yin of the National Center for STD Control & Chinese Academy of Medical Sciences, also indicated that the frequency of dual resistance to these agents in N. gonorrhoeae isolates increased from 2013 to 2016. The results suggest that dual therapy with azithromycin and ceftriaxone, which is WHO-recommended in many countries to treat gonorrhea, may not be working in China.
China has an increased rate of antimicrobial consumption, but has limited data on antimicrobial resistance in gonorrhea. Antimicrobial resistance in N. gonorrhoeae is a global threat in the control of this infection. In this study, minimum inhibitory concentrations (MICs) of azithromycin and ceftriaxone were determined for 3,849 clinical isolates from patients with gonorrhea who provided samples during the time period 2013 to 2016 in 7 provinces in China. Yin and colleagues discovered high prevalence of resistance to azithromycin (RTA; 18.6%; 95% CI 17.4%-19.8%) and decreased susceptibility to ceftriaxone (DSC; 10.8%; 95% CI 9.9%-11.9%) in the study population. The prevalence of concomitant RTA and DSC increased from 1.9% in 2013 to 3.3% in 2016 (chi-squared test for trend, P = 0.03).
The study uses a convenience sample of clinical isolates, and most participants were male, symptomatic, heterosexual, and living in coastal locations. However, to our knowledge this is the first national study on susceptibility of N. gonorrhoeae to azithromycin and ceftriaxone in China.
According to the researchers; “It is important that clinicians be on high alert to recognize gonorrhea treatment failures so that they can be reported promptly to public health officials. The high and increasing prevalence of RTA/DSC found in the current study suggests the need for further consideration and validation of an appropriate regimen for treatment of gonorrhea in China.”