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The rates of drug-resistant gonorrhea
in the United States have increased so greatly in the
last five years that doctors should now treat the infection
with a different class of antibiotics, the last line
of defense for the sexually transmitted disease, officials
said yesterday.
The percentage of drug-resistant gonorrhea
cases among heterosexual men jumped, to 6.7 percent
in 2006 compared with 0.6 percent in 2001, officials
from the Centers for Disease Control and Prevention
said.
Standard monitoring of gonorrhea cases
is conducted among men who go to S.T.D. clinics. New
data from such sites in 26 cities show that rates of
drug-resistant gonorrhea among heterosexual men at the
clinics last year reached 26 percent in Philadelphia
and more than 20 percent in Honolulu and four areas
in California, Long Beach, Orange County, San Diego
and San Francisco.
Among gay men at the clinics, the rates
of the bacterial infection jumped, to 38 percent in
the first half of 2006 from 1.6 percent in 2001.
For 14 years, most cases of gonorrhea
have been treated with a class of antibiotics known
as fluoroquinolones. Now, officials at the center are
urging doctors to prescribe drugs in the cephalosporin
class.
No new antibiotics for gonorrhea are
in the pipeline, officials of the centers told reporters
by telephone.
"Now we are down to one class of
drugs," said Dr. Gail Bolan, an expert in sexually
transmitted diseases at the California Department of
Health Services. "That's a very perilous situation
to be in."
Dr. Bolan is a spokeswoman for the Infectious
Diseases Society of America, a professional organization.
Health officials are also concerned
about extremely drug-resistant tuberculosis and a number
of other microbes like Pseudomonas aeruginosa, Klebsiella
penumoniae and Acinetobacter species that are resistant
to most antibiotics.
The United States has an estimated 700,000
new cases of gonorrhea a year, occurring among sexually
active people of both genders at all ages. It is the
second most commonly reported infectious disease, behind
chlamydia, another sexually transmitted disease.
After a substantial decline from 1975
to 1997, the gonorrhea rates had leveled off in recent
years.
Action was taken yesterday because the
level of resistance has exceeded the standard of 5 percent
set by the centers and the World Health Organization.
Although the centers' recommendations are not binding,
physicians generally follow them.
"We are running out of options,"
said Dr. John M. Douglas Jr., who directs the division
of sexually transmitted diseases prevention at the centers.
Cephalosporins, like their cousin penicillin, thwart
bacteria by damaging a microbe's cell wall, not by attacking
DNA as the fluoroquinolones do, Dr. Douglas said.
Gonorrhea has not shown resistance to
the cephalosporins, which were first marketed in the
United States in the 1980s, Dr. Douglas said. Now "increased
vigilance is essential," he said, because resistance
could still develop at any time, particularly with increased
usage.
The disease centers say doctors should
now prescribe ceftriaxone, sold as Rocephin, which is
injected once into a muscle. The centers also recommend
the one-time use of cefixime, or Suprax, but tablets
of cefixime are not available in the recommended 400-milligram
dose.
These drugs are meant to substitute
for the three currently recommended fluoroquinolones,
ciprofloxacin, or Cipro; ofloxacin, or Floxin; and levofloxacin,
or Levaquin.
For patients allergic to cephalosphins,
the centers recommend one injection of spectinomycin,
a drug not available in the United States.
Over the years, gonorrhea has become
resistant to a number of antibiotic classes starting
with sulfa, then penicillin and the tetracyclines before
fluoroquinolones.
The disease centers have gradually cautioned
against using fluoroquinolones because of the emergence
of resistance in different regions.
In 2000, the centers recommended against
fluoroquinolones for any patient who acquired gonorrhea
in Hawaii, other Pacific Islands and Asia. The agency
extended the recommendation to California in 2002. In
2004, the centers recommended that fluoroquinolones
not be used among gay men with gonorrhea.
In 2005, Britain recommended against
using fluoroquinolones for gonorrhea because of a resistance
problem there.
The centers do not plan a letter to
doctors on the recommendations. They are relying on
news reports and state and local health departments
to spread the information.
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