The Pharmaceutical Journal
Vol 270 No 7252 p781
7 June 2003

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The Lancet (www.thelancet.com)
GRASP:The Gonococcal Resistance to Antimicrobials Surveillance Programme (more)

Call for new guidelines for gonorrhoea treatment as ciprofloxacin resistance rises

National and local treatment guidelines for gonorrhoea must be urgently reviewed in the light of new evidence showing a large increase in ciprofloxacin resistance, according to the Gonococcal Resistance to Antimicrobials Surveillance Programme.

Surveillance has shown a 9.8 per cent overall prevalence of ciprofloxacin resistance in 2002. This is a steep rise compared with rates of 3.1 per cent in 2001 and 2.1 per cent in 2000, found from tests of gonococcal isolates (Lancet 2003;361:1867).

Kevin Fenton of the Health Protection Agency said: "United Kingdom national guidelines recommend three first line options for the treatment of gonorrhoea: ciprofloxacin, ofloxacin and ampicillin/probenecid. To prevent the spread of gonorrhoea, the chosen treatment should clear up at least 95 per cent of infections, and ciprofloxacin no longer meets this criterion. This is why we are recommending a review of treatment guidelines and the use of antibiotics such as cephalosporins or spectinomycin, so that infections are treated quickly and effectively."

Treatment reports show that about 74 per cent of clinics use ciprofloxacin first line, although in London amoxicillin/probenecid is used in 39 per cent of patients.