812 OMINOUS AZITHROMYCIN RESISTANCE TREND OF GONOCOCCAL URETHRITIS IN JAPAN (2010)

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 2010812 OMINOUS AZITHROMYCIN RESISTANCE TREND OF GONOCOCCAL URETHRITIS IN JAPAN Motoo Araki, Shinya Uehara, Ayano Ishii, Hiroyuki Nose, Toyohiko Watanabe, Satoshi Uno, Koichi Monden, Tohru Araki, Yasutomo Nasu, and Hiromi Kumon Motoo ArakiMotoo Araki Okayama, Japan , Shinya UeharaShinya Uehara Okayama, Japan , Ayano IshiiAyano Ishii Okayama, Japan , Hiroyuki NoseHiroyuki Nose Okayama, Japan , Toyohiko WatanabeToyohiko Watanabe Okayama, Japan , Satoshi UnoSatoshi Uno Okayama, Japan , Koichi MondenKoichi Monden Kurashiki, Japan , Tohru ArakiTohru Araki Kurashiki, Japan , Yasutomo NasuYasutomo Nasu Okayama, Japan , and Hiromi KumonHiromi Kumon Okayama, Japan View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1488AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Gonococcal urethritis is increasing because oral sex has become a general sexual behavior. CDC recommends Cefrtiaxone (CTRX) IM or Cefixime (CFIX) orally. However, many treatment failures by oral CFIX have been reported in Japan. Therefore, Japanese guideline does not recommend any oral antibiotics. This creates a problem in terms of cost-effectiveness and also for the treatment of patients who are allergic to cephalosporins. In May 2004, azithromycin (AZM) 1g orally in a single dose was approved for the treatment of Chlamydia urethritis in Japan. Then, in April 2009, AZM 2g orally in a single dose was approved for the treatment of gonococcal urethritis in Japan. The aim of this study was to analyze the trend in AZM susceptibility of Neisseria gonorrhoeae (NG). METHODS NG consecutive isolates were collected from gonococcal urethritis patients at Okayama University Hospital, other 4 hospitals and 3 clinics in Japan between 2004 and 2008. The minimum inhibitory concentrations (MICs) of the isolates were determined by the agar dilution method for penicillin G (PCG), minomycin (MINO), spectinomycin (SPCM), CTRX, CFIX, ofloxacin (OFLX) and AZM. On the basis of definitions used in the literature, isolates were considered to be resistant if their MICs (μg/ml) are the following; PCG (≥ 2), MINO (≥ 2), SPCM (≥ 128), CTRX (≥ 0.5), CFIX (≥ 0.5), OFLX (≥ 0.5), AZM (≥ 1). RESULTS Three hundred and two patients were included in this study. Median age was 27 years old. Major infection source was heterosexual commercial sex worker. Infection by oral sex alone has rapidly increased from 22 % (2004) to 55 % (2008). The incidence of co-infection of Chlamydia trachomatis was 7 to 17% each year. Antibiotic resistance rate are shown in the Table 1. Although AZM had not been used for the treatment of NG urethritis during this period, AZM resistant rate has increased from 9.4% to 20%. CONCLUSIONS This study supports the continued use of CTRX and SPCM for the primary treatment of gonococcal infections in Japan. AZM resistant rate is increasing despite the fact that it had not been used for the treatment of NG urethritis. A 2g dose of AZM may not be considered as an alternative antibiotic therapy for gonococcal infections. The use of AZM to treat Chlamydia in patients co-infected with NG results in a level of AZM in vivo that is sublethal for NG which may lead to resistance. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e317 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Motoo Araki Okayama, Japan More articles by this author Shinya Uehara Okayama, Japan More articles by this author Ayano Ishii Okayama, Japan More articles by this author Hiroyuki Nose Okayama, Japan More articles by this author Toyohiko Watanabe Okayama, Japan More articles by this author Satoshi Uno Okayama, Japan More articles by this author Koichi Monden Kurashiki, Japan More articles by this author Tohru Araki Kurashiki, Japan More articles by this author Yasutomo Nasu Okayama, Japan More articles by this author Hiromi Kumon Okayama, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...