Cefixime no longer recommended for treatment of gonorrhea

The spread of antimicrobial resistance has claimed another victim. According to the Centers for Disease Control and Prevention (CDC), gonorrhea should no longer be treated with cefixime as a first-line therapy. The CDC updated its treatment guidelines in the August 10 issue of Morbidity and Mortality Weekly Report.

Neisseria gonorrhoeae is highly prevalent and an important cause of pelvic inflammatory disease, ectopic pregnancy, infertility, and the spread of HIV infection. The CDC conducts periodic gonorrhea surveillance through its Gonococcal Isolate Surveillance Project. Laboratory studies for 2006-2011 indicate that urethral N gonorrhoeae has developed resistance to cefixime, which is therefore no longer recommended at any dose for first-line therapy.

Instead, the CDC states that uncomplicated urogenital, anorectal, or pharyngeal gonorrhea should be treated with combination therapy with ceftriaxone 250 mg intramuscularly plus either azithromycin in a single dose of 1 g orally or doxycycline at 100 mg orally twice a day for 1 week. Treatment failure should be addressed by culture and antimicrobial susceptibility testing. Cefixime and other medications can be considered as second-line agents, followed by a test-of-cure 1 week later. Sex partners also require treatment.

The need for the guideline revision comes as no surprise, given that N gonorrhoeae has previously developed resistance to fluoroquinolones, prompting the CDC to recommend cephalosporins instead, and the recent discovery of declining effectiveness of cefixime. CDC hopes that the restriction of cefixime use will also delay the development of resistance to ceftriaxone.

Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections. Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep. 2012;61:590-594.