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Editor,— Since the 1940s, penicillin has been recommended for the treatment of gonorrhoea. In the 1950s the first strains of Neisseria gonorrhoeae with reduced susceptibility to this antibiotic, as a result of chromosomal mutations, were isolated, and in 1976 the first penicillinase producing Neisseria gonorrhoeae (PPNG) strains emerged in South East Asia and Africa, causing high level resistance to penicillin (MIC 16 μg/ml).1 In Cuba, the first report of a PPNG strain was made in 1986 (C Almanza, personal communication). We report here on the proportion of PPNG strains received at the Neisseria Reference Laboratory, Tropical Medicine Institute “Pedro Kouri” (IPK), Cuba between January 1995 and December 1998.
In all, 110 strains of N gonorrhoeae isolated from 10 of the 14 Cuban provinces were examined for their β lactamase activity by the chromogenic method (Nitrocefin, Oxoid). These strains were transported to the IPK using a novel transport and conservation medium for gonococci developed at our laboratory.2 N gonorrhoeae WHO E and WHO A were used as positive and negative control strains, respectively. All strains were identified as gonococci by standard procedures.3
Table 1 shows the distribution of Cuban PPNG and non-PPNG strains detected in our laboratory during 1995–8. The PPNG strains predominated totally (61/110, 55.5%). The percentage of PPNG strains was high in all years analysed.4 To our knowledge it is the first study developed in Cuba, analysing the β lactamase activity of N gonorrhoeae isolated from different provinces in which a high percentage of PPNG strains was found. Previous studies developed in specific Cuban hospitals in Havana City have revealed a lower percentage of PPNG strains (M Berroa et al, 1988; C Almanza et al, 1988, personal communications).
Penicillin has been the drug of choice for treatment of gonococcal infections in Cuba since 1972.5 The results of this study indicate that any policy to treat such infections should not include penicillin or other similar drugs. Other antimicrobials recommended by the World Health Organisation for treatment gonorrhoea—for example, spectinomycin, cephalosporins, quinolones, and azithromycin have been recently evaluated in Cuba with good results (R Llanes, et al, unpublished data, 1999).
We thank Lic D Guzman, Lic Y Gutierrez, and O Gutierrez for their technical support during this study and Dr A Llop for her revision.
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