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• W1992642313 abstract "Catherine Ison and colleagues1Ison CA Town K Obi C et al.for the GRASP collaborative groupDecreased susceptibility to cephalosporins among gonococci: data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England and Wales, 2007–2011.Lancet Infect Dis. 2013; 13: 762-768Summary Full Text Full Text PDF PubMed Scopus (112) Google Scholar show a rise in the prevalence of gonococcal strains with decreased susceptibility to both oral cefixime and injectable ceftriaxone in England and Wales from 2007 to 2010. They also show a significant fall in the prevalence of strains with decreased susceptibility to cefixime between 2010 and 2011. The authors attributed this decrease to a change in prescribing practices between 2010 and 2011 from cefixime to ceftriaxone. We think that these findings raise several questions. First, the authors chose a breakpoint of 0·125 mg/L or more for minimal inhibitory concentration (MIC) to define the decreased susceptibility to cefixime, which is not the usual threshold. Both the European Committee on Antimicrobial Susceptibility Testing and the Gonococcal Isolate Surveillance Project in the USA consider that isolates have a decreased susceptibility when MICs are 0·250 mg/L or higher. The distribution of MICs of cefixime in England and Wales1Ison CA Town K Obi C et al.for the GRASP collaborative groupDecreased susceptibility to cephalosporins among gonococci: data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England and Wales, 2007–2011.Lancet Infect Dis. 2013; 13: 762-768Summary Full Text Full Text PDF PubMed Scopus (112) Google Scholar shows that far fewer than 5% of strains had an MIC of at least 0·250 mg/L, except in 2010. It is possible that univariate and multivariate analyses would have yielded different results with a breakpoint of 0·250 mg/L. Second, the improvement of susceptibility through clinicians' stopping the use of an antibiotic is an encouraging finding. However, it is surprising that such a recent change in prescribing practice was the only factor to explain the rapid decline in decreased susceptibility.2Yates RR New intervention strategies for reducing antibiotic resistance.Chest. 1999; 115: 24S-27SCrossref PubMed Scopus (97) Google Scholar, 3Seppälä H Klaukka T Vuopio-Varkila J et al.The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance.N Engl J Med. 1997; 337: 441-446Crossref PubMed Scopus (1061) Google Scholar In France, we have not seen such a trend, despite the fact that ceftriaxone has been the first-line treatment for gonorrhoea since 2006, and cefixime is reserved for patients who refuse the injection.4Agence française de sécurité sanitaire des produits de santé (Afssaps)[Antibiotherapy applied to uncomplicated urethritis and cervicitis. French Agency for Health Product Safety].Med Mal Infect. 2006; 36: 27-35Crossref PubMed Scopus (7) Google Scholar The proportion of strains resistant to cefixime (MICs greater than 0·125 mg/L) was lower than 1% in 2011 (0·7% in 2011; 95% CI 0·3–1·2), but increased significantly to 3·0% in 2012 (95% CI 2·1–4·2; p<0·001).5La Ruche G Sednaoui P Bercot B Cambau E Goubard A Evolution of gonococcal strain susceptibility to antibiotics in France: data from a national sentinel surveillance network, 2001–2012. International Meeting on Emerging Diseases and Surveillance; Vienna, Austria; 15–18 Feb 2013. Abstract 17.008.http://www.isid.org/events/archives/IMED2013/downloads/FinalProgram.pdfGoogle Scholar Meanwhile, only two of 8649 strains collected between 2001 and 2012 had an MIC of ceftriaxone greater than 0·125 mg/L, both obtained in 2010.5La Ruche G Sednaoui P Bercot B Cambau E Goubard A Evolution of gonococcal strain susceptibility to antibiotics in France: data from a national sentinel surveillance network, 2001–2012. International Meeting on Emerging Diseases and Surveillance; Vienna, Austria; 15–18 Feb 2013. Abstract 17.008.http://www.isid.org/events/archives/IMED2013/downloads/FinalProgram.pdfGoogle Scholar French data are consistent with that of treatment failures. Moreover, resistance to ceftriaxone remains very rare worldwide. Finally, the authors gave no information about the anatomical site of gonococcal infections, which could have a role in the risk analysis of resistance. Through the French laboratory network, we have shown that mean MICs of cefixime and ceftriaxone were significantly higher for pharyngeal isolates collected between 2008 and 2012 than were those for urogenital or anal isolates.6La Ruche G Goubard A Berçot B Cambau E Semaille C Sednaoui P [Trends of antibiotic resistance of Neisseria gonorrhoeae in France, from 2001 to 2012].Bull Epidemiol Hebd. 2014; 5 (accessed Feb 4, 2014).: 93-103http://www.invs.sante.fr/beh/2014/5/2014_5_2.htmlGoogle Scholar We declare that we have no conflicts of interest. Decreased susceptibility to cephalosporins among gonococci: data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England and Wales, 2007–2011Guidance for treatment of gonorrhoea in England and Wales was changed in 2010 to prolong the use of cephalosporins. The decline in prevalence of isolates with decreased cefixime susceptibility cannot be attributed unequivocally to this change in prescribing practice; however, the association is striking. Full-Text PDF Decreased susceptibility to cephalosporins among gonococci? – Authors' replyWe read with interest the Correspondence about our Article on decreased susceptibility to cephalosporins among gonococci in England and Wales,1 and welcome the data shared from Australia, France, and Japan. We are encouraged to note that, in Australia, gonococcal isolates with decreased susceptibility to ceftriaxone fell from 2010 to 2011, similar to our findings for susceptibility to cefixime. In both instances, the fall was associated with increased dosage of ceftriaxone; albeit as monotherapy in Australia, whereas dual therapy (in combination with azithromycin) was used in the UK. Full-Text PDF" @default.
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• W1992642313 title "Decreased susceptibility to cephalosporins among gonococci?" @default.
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