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Quinolone resistance in Neisseria gonorrhoeae

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Abstract

Single-dose oral quinolones have been recommended for gonorrhea treatment since 1989. The antimicrobial resistance surveillance system has detected several outbreaks of quinolone-resistant gonococcal infections (QRNG), and sporadic treatment failures have been reported from high-incidence areas such as southeast Asia. QRNG may result from mutations that cause structural-functional changes in DNA topoisomerase (the quinolone target enzyme) or by changes in antimicrobial transport into the bacteria. QRNG has occurred sporadically in the United States, predominantly in persons with contact to persons in southeast Asia, and has typically occurred as an epiphenomenon in persons who were treated with other regimens. Nevertheless, this entity warrants close monitoring. The emergence of QRNG is probably related to antimicrobial misuse and overuse, in particular long-term suppressive or subtherapeutic doses.

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References and Recommended Reading

  1. Phillips I: Beta-lactamase-producing penicillin resistant gonococcus. Lancet 1976, 2:656–657.

    Article  PubMed  CAS  Google Scholar 

  2. Ashford WA, Golash RG, Hemming VG: Penicillinase-producing Neisseria gonorrhoeae. Lancet 1976, 2:657–658.

    Article  PubMed  CAS  Google Scholar 

  3. Sexually transmitted diseases treatment guidelines. MMWR Morb Mortal Wkly Rep 1993, 42(RR-14):4–5.

  4. 1998 sexually transmitted diseases treatment guidelines. MMWR Morb Mortal Wkly Rep 1998, 47(RR-1):59–63.

  5. Moran JS, Levine WC: Drugs of choice for the treatment of uncomplicated gonococcal infections. Clin Infect Dis 1995, 20(suppl 1):S47-S65.

    PubMed  Google Scholar 

  6. Fox KK, Knapp JS, Holmes KK, et al.: Antimicrobial resistance in Neisseria gonorrhoeae in the United States 1988–1994: the emergence of decreased susceptibility to the fluoroquinolones. J Infect Dis 1997, 175:1396–1403. A summary of the categories of resistance used by and monitored for the United States GISP and comparisons of the levels of antimicrobial resistance in the early 1990s.

    Article  PubMed  CAS  Google Scholar 

  7. Performance Standards for Antimicrobial Disk Susceptibility Tests, edn 5. Villanova, PA: National Committee for Clinical Laboratory Standards; 1993:1-32. NCCLS document no. M2-A5.

  8. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically, edn 3. Villanova, PA: National Committee for Clinical Laboratory Standards; 1993:1–32. NCCLS document no. M7-A3.

  9. Knapp JS, Hale JA, Wintersheid K, et al.: Proposed criteria for the interpretation of susceptibilities of strains of Neisseria gonorrhoeae isolates to ciprofloxacin, ofloxacin, enoxacin, lomefloxacin and norfloxacin. Antimicrob Agents Chemother 1995, 39:2442.

    PubMed  CAS  Google Scholar 

  10. Approved Standard M100-38. Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA: National Committee for Clinical Laboratory Standards; 1998.

  11. Mandell GL, Bennett JE, Dolia R: Principles and Practice of Infectious Diseases, edn 5. Philadelphia: Churchill Livingstone; 2000.

    Google Scholar 

  12. Wolfson JS, Hooper DC: The fluoroquinolones: structures, mechanisms of action and resistance and spectra of activity in vitro. Antimicrob Agents Chemother 1985, 28:581–586.

    PubMed  CAS  Google Scholar 

  13. Belland RJ, Morrison SG, Ison C, et al.: N. gonorrhoeae acquires mutations in analogous regions of gyrA and parC in fluoroquinolone-resistant isolates. Mol Microbiol 1994, 14:371–380.

    Article  PubMed  CAS  Google Scholar 

  14. Deguchi T, Yasuda M, Asano M, et al.: DNA gyrase mutations in quinolone-resistance clinical isolates of N. gonorrhoeae. Antimicrob Agents Chemother 1995, 39:561–563.

    PubMed  CAS  Google Scholar 

  15. Wolfson JS, Hooper DC: Bacterial resistance to quinolones: mechanisms and clinical importance. Rev Infect Dis 1989, 11(suppl):960–968.

    Google Scholar 

  16. Deguchi T, Yasuda M, Nakano M, et al.: Quinolone-resistant N. gonorrhoeae: correlation of alterations in the GyrA subunit of DNA gyrase and the ParC subunit of topoisomerase IV with antimicrobial susceptibility profiles. Antimicrob Agents Chemother 1996, 40:1020–1023.

    PubMed  CAS  Google Scholar 

  17. Tanaka M, Takahashi K, Saika T, et al.: Development of fluoroquinolone resistance and mutations involving GyrA and ParC proteins among Neisseria gonorrhoeae isolates in Japan. J Urol 1998, 159:2215–2219.

    Article  PubMed  CAS  Google Scholar 

  18. Tanaka M, Matsumoto T, Sakumoto M, et al.: Reduced clinical efficacy of pazufloxacin against gonorrhea due to high prevalence of quinolone-resistant isolates with the GyrA mutation. Antimicrob Agents Chemother 1998, 42:579–582.

    PubMed  CAS  Google Scholar 

  19. Corkill JE, Percival A, Lind M: Reduced uptake of ciprofloxacin in a resistance strain of N. gonorrhoeae and transformation of resistance to other strains. J Antimicrob Chemother 1991, 28:601–604.

    Article  PubMed  CAS  Google Scholar 

  20. Tanaka M, Fukuda H, Hirai K, et al.: Reduced uptake and accumulation of norfloxacin in resistant strains of Neisseria gonorrhoeae isolated in Japan. Genitourinar Med 1994, 70:253–255.

    CAS  Google Scholar 

  21. Hooper DC, Wolfson JS, Ng EY, et al.: Mechanism of action and resistance to ciprofloxacin. Am J Med 1987, 82:12–20.

    PubMed  CAS  Google Scholar 

  22. T Deguchi, Saito I, Tanaka M, et al.: Fluoroquinolone treatment failure in gonorrhea: emergence of a N. gonorrhoeae strain with enhanced resistance to fluoroquinolones. Sex Transm Dis 1997, 24:247–250. One of the first studies suggesting that quinolone resistance increases with multiple quinolone therapies and that cross-resistance to cephalosporins may develop.

    Article  PubMed  CAS  Google Scholar 

  23. Tanaka M, Nakayama H, Haraoka M, et al.: Analysis of quinolone resistance mechanisms in a sparfloxacin-resistant clinical isolate of Neisseria gonorrhoeae. Sex Transm Dis 1998, 25:489–493. A report of quinolone resistance and the resistance mechanisms associated with one of the newest of the class (sparfloxacin) in Japan.

    Article  PubMed  CAS  Google Scholar 

  24. Knapp JS, Mesola V, Neal SW, et al.: Molecular epidemiology in 1994 of Neisseria gonorrhoeae in Manila and Cebu City, Republic of the Philippines. Sex Transm Dis 1997, 24:1–7.

    Article  Google Scholar 

  25. Knapp JS, Wongba C, Limpakarnjanarat L, et al.: Antimicrobial susceptibilities of Neisseria gonorrhoeae in Bangkok, Thailand: 1994–6. Sex Transm Dis 1997, 24:142–148.

    Article  PubMed  CAS  Google Scholar 

  26. Deguchi T, Yasuda M, Nakano M, et al.: Quinolone-resistance in N. gonorrhoeae: correlation of alterations in the GyrA subunit of DNA gyrase and the ParC subunit of topoisomerase IV with antimicrobial susceptibility profiles. Antimicrob Agents Chemother 1996, 40:1020–1023.

    PubMed  CAS  Google Scholar 

  27. Kam KM, Lo KK, Ng KYH, et al.: Rapid decline in penicillinaseproducing Neisseria gonorrhoeae in Hong Kong associated with emerging 4-fluoroquinolone resistance. Genitourinar Med 1995, 71:141–144.

    CAS  Google Scholar 

  28. Kam KM, Lo KK, Lai CF, et al.: Ofloxacin susceptibilities of 5,667 Neisseria gonorrhoeae strains isolated in Hong Kong. Antimicrob Agents Chemother 1993, 37:2007–2008.

    PubMed  CAS  Google Scholar 

  29. Knapp JS: Neisseria gonorrhoeae resistant to ciprofloxacin and ofloxacin. Sex Transm Dis 1998, 25:425–426.

    Article  PubMed  CAS  Google Scholar 

  30. Knapp JS, Fox KK, Trees DL, et al.: Fluoroquinolone resistance in Neisseria gonorrhoeae. Emerg Infect Dis 1997, 3:33–39.

    Article  PubMed  CAS  Google Scholar 

  31. Tapsall JW, Limnios EA, Shultz TR: Continuing evolution of the pattern of quinolone resistance in Neisseria gonorrhoeae isolated in Sydney, Australia. Sex Transm Dis 1998, 25:415–417. This report describes the pattern of increasing quinolone resistance in the late 1990s to endemic levels and suggests that efforts at the governmental level be focused on limiting spread of QRNG in international commercial sex workers.

    Article  PubMed  CAS  Google Scholar 

  32. Schwarcz SK, Zenilman JM, Schnell D, et al.: National surveillance of antimicrobial resistance in Neisseria gonorrhoeae. JAMA 1990, 264:1413–1417.

    Article  PubMed  CAS  Google Scholar 

  33. Knapp JS, Washington JA, Doyle LJ, et al.: Persistence of Neisseria gonorrhoeae strains with decreased susceptibilities to ciprofloxacin and ofloxacin in Cleveland, Ohio from 1992 through 1993. Antimicrob Agents Chemother 1994, 38:2194–2196.

    PubMed  CAS  Google Scholar 

  34. Gordon SM, Carlyn CJ, Doyle LJ, et al.: The emergence of Neisseria gonorrhoeae with decreased susceptibility to ciprofloxacin in Cleveland, Ohio: epidemiology and risk factors. Ann Intern Med 1996, 125:465–470.

    PubMed  CAS  Google Scholar 

  35. Fluoroquinolone resistance in Neisseria gonorrhoeae—Colorado and Washington, 1995. MMWR Morb Mortal Wkly Rep 1995, 20:761–764.

  36. US Department of Health and Human Services, Public Health Service, Division of STD Prevention: Sexually Transmitted Disease Surveillance 1998 Supplement: Gonococcal Isolate Surveillance Project (GISP) Annual Report—1998. Atlanta: Centers for Disease Control and Prevention; 1999.

    Google Scholar 

  37. US Department of Health and Human Services, Public Health Service: Sexually Transmitted Disease Surveillance 199 Supplement: Gonococcal Isolate Surveillance Project (GISP) Annual Report — 1999. Atlanta: Centers for Disease Control and Prevention; 2000.

    Google Scholar 

  38. Zenilman JM: Gonococcal susceptibility to antimicrobials in Baltimore, 1988–1994. What was the impact of ciprofloxacin as first-line therapy for gonorrhea? Sex Transm Dis 1996, 23:213–218.

    Article  PubMed  CAS  Google Scholar 

  39. Richard P, Delangle MH, Merrian D, et al.: Fluoroquinolone use and fluoroquinolone resistance: is there an association? Clin Infect Dis 1994, 19:54–59.

    PubMed  CAS  Google Scholar 

  40. Gordon SM, Mosure DJ, Lewis J, et al.: Prevalence of selfmedication with antibiotics among patients attending a clinic for treatment of sexually transmitted diseases. Clin Infect Dis 1993, 17:462–465.

    PubMed  CAS  Google Scholar 

  41. US Department of Health and Human Services, Public Health Service, Division of STD Prevention: Sexually Transmitted Disease Surveillance, 1994. Atlanta: Centers for Disease Control and Prevention; 1995:5–17.

    Google Scholar 

  42. Handsfield HH, Whittington WL: Antibiotic-resistant Neisseria gonorrhoeae: the calm before another storm? Ann Intern Med 1996, 125:507–508.

    PubMed  CAS  Google Scholar 

  43. Thomas L: The Lives of a Cell; Notes of a Biology Watcher. New York: Viking Press; 1974:78.

    Google Scholar 

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  1. Johns Hopkins University School of Medicine, Ross 1165, 720 Rutland Avenue, 21205, Baltimore, MD, USA

    Janine R. Tompkins MPH & Jonathan M. Zenilman MD

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  1. Janine R. Tompkins MPH
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  2. Jonathan M. Zenilman MD
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Tompkins, J.R., Zenilman, J.M. Quinolone resistance in Neisseria gonorrhoeae. Curr Infect Dis Rep 3, 156–161 (2001). https://doi.org/10.1007/s11908-996-0041-5

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