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Implications of current recommendations for third-generation cephalosporins use in the WHO Western Pacific region following the emergence of multi-resistant gonococci.
  1. John W Tapsall (j.tapsall{at}
  1. WHO Collaborating Centre for STD, Microbiology Deparatment , The Prince of Wales Hospital, Sydney, Australia


    Objectives: To ascertain recommendations for treatment of gonorrhoea in the WHO Western Pacific Region (WPR) following emergence of 'cephalosporin-resistant' Neisseria gonorrhoeae and to relate these to clinical and laboratory measures directed towards disease and antibiotic resistance control.

    Methods: WHO WPR Gonococcal Antimicrobial Resistance Programme members provided data on the type, dose and source of third-generation cephalosporins recommended for the treatment of gonorrhoea.

    Results: Ceftriaxone was recommended more widely (11of 15 respondents) than cefixime (5 centres). No cephalosporins were recommended in three jurisdictions. One other oral (ceftibuten) and injectable (cefodizime) agent was recommended. Uniform (400 mg) doses of cefixime were recommended but ceftriaxone regimens ranged between 125mg and 1g with nine of 11 respondents using a 250mg dose. Both generic and proprietary preparations were widely used.

    Conclusions: Third-generation cephalosporins are widely recommended for treatment of gonorrhoea in the WPR, with injectable ceftriaxone more extensively so than oral cefixime and in an expanded dose range. Few other cephalosporins were recommended. Current knowledge suggests that the trend to ceftriaxone treatment in higher doses may decrease the impact of the circulation of 'cephalosporin-resistant' gonococci in the WPR. However these recommendations represent public sector practice only and of themselves are unlikely to contain the further spread of 'cephalosporin-resistant' gonococci because of general clinical use of cephalosporins. Optimisation of strategies for laboratory detection of third-generation cephalosporin resistance can be simplified in the WPR because of the restricted spectrum of cephalosporins recommended. Additional efforts are urgently required for both disease and antibiotic resistance control in gonorrhoea.

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