Abstract
Background General practitioners (GPs) as a group have been identified as playing an important role in gonorrhoea management in Flanders. Belgian guidelines recommended ceftriaxone or alternatively spectinomycin from 2008 onwards and azithromycin combination therapy since 2012. Objectives This study investigates to which extent contemporary gonorrhoea treatment guidelines were followed. Methods A retrospective cohort study (2009–2013) of antibiotic prescriptions for gonorrhoea cases registered in the Flemish Intego general practice database was carried out. The database is based on electronic health record routine registration by over 90 GPs using the software programme Medidoc. Results Ninety-one gonorrhoea cases with ten chlamydia and one genital trichomonas coinfections in 90 patients were registered between 2009 and 2013. The proportion of cases with ceftriaxone and/or spectinomycin prescriptions rose from 13% (two of 15 cases) in 2009 to 56% (nine of 16 cases) in 2013. Combination therapy of ceftriaxone and/or spectinomycin together with azithromycin rose from 0 of 15 cases (0%) in 2009 to 7 of 16 cases (44%) in 2013. Conclusion Although numbers are small, the results suggest that gonorrhoea therapy guideline adherence improved between 2009 and 2013.
Highlights
As in other parts of Europe [1, pp. 19-20], the number of newly diagnosed gonorrhoea cases has been increasing in Flanders since 2009 [2, p. 26]
Given the fact that ceftriaxone and spectinomycin were recommended throughout the observation period, that azithromycin was recommended formally since 2012/2013, and that it takes time to spread the new version of a guideline, the best proxy for gonorrhoea guideline adherence 2009–2012 seems to be the prescription of ceftriaxone and/or spectinomycin, with 2013 being a transition year, and from 2014 onward the combination therapy of ceftriaxone and/or spectinomycin together with azithromycin
Given the global threat of antimicrobial resistance and substantial General practitioners (GPs) involvement in gonorrhoea control in Flanders, monitoring GPs’ therapeutic choices including adherence to national treatment guidelines remains important, especially if monitoring is possible from routine registration
Summary
As in other parts of Europe [1, pp. 19-20], the number of newly diagnosed gonorrhoea cases has been increasing in Flanders since 2009 [2, p. 26]. 19-20], the number of newly diagnosed gonorrhoea cases has been increasing in Flanders since 2009 [2, p. Figures from the Flemish Agency for Care and Health [3] show an increase from 622 gonorrhoea cases in 2009 to 1162 cases in 2013 [4]. Belgian guidelines recommended ceftriaxone or alternatively spectinomycin from 2008 onwards and azithromycin combination therapy since 2012. A retrospective cohort study (2009–2013) of antibiotic prescriptions for gonorrhoea cases registered in the Flemish Intego general practice database was carried out. Combination therapy of ceftriaxone and/or spectinomycin together with azithromycin rose from 0 of cases (0%) in 2009 to 7 of cases (44%) in 2013. The results suggest that gonorrhoea therapy guideline adherence improved between 2009 and 2013
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