Abstract
BackgroundSexually transmitted infections (STI) caused by multidrug resistant Neisseria gonorrhoea are an emerging threat to global health. In the Netherlands, the general practitioner (GP) provides the major part of STI care. In 2013 an update of the Dutch guideline was published, recommending a single dose of intramuscular ceftriaxone as treatment for gonorrhoea infections. Data from a Dutch General Practitioner research database was used to investigate the guideline implementation for the treatment of gonorrhoea. A survey was conducted to gain more insight in GPs experiences with the recommended intramuscular therapy.MethodsData on STI-related episodes and STI-diagnoses for gonorrhoea, based on ICPC codes were obtained from the electronic medical records (EMRs) from 35 GPs in Amsterdam for the years 2010 to 2016. Questionnaires regarding the treatment preferences were sent to GPs participating in the research network database.ResultsThe number of gonorrhoea cases treated with first choice therapy increased from 81% in 2010 (intramuscular cefotaxime or ceftriaxone) to 93% in 2015 (only cefttriaxone). The number of ceftriaxone prescriptions increased substantially from 30% in 2010 to 93% in 2015. GPs preferred a single intramuscular shot of a third-generation cephalosporin above multiple oral doses of other antibiotics.ConclusionsThe results demonstrate a successful shift in the antimicrobial management of gonorrhoea infections to ceftriaxone monotherapy according to the national guideline. GPs in this higher prevalence area in Amsterdam reported limited barriers in the intramuscular administration of third-generation cephalosporins.
Highlights
Transmitted infections (STI) caused by multidrug resistant Neisseria gonorrhoea are an emerging threat to global health
Since it is uncertain whether dual therapy has additional benefit in the control of antimicrobial resistance compared with monotherapy, the Dutch Sexually transmitted infections (STI) guideline recommends monotherapy with an intramuscular dose of a third-generation cephalosporin [7]
We investigated the implementation of the updated Dutch STI guideline and explored experiences with the recommended intramuscular therapy among general practitioner (GP) in Amsterdam, the Netherlands, between 2010 and 2016
Summary
Transmitted infections (STI) caused by multidrug resistant Neisseria gonorrhoea are an emerging threat to global health. In 2013 an update of the Dutch guideline was published, recommending a single dose of intramuscular ceftriaxone as treatment for gonorrhoea infections. In the Netherlands, dual therapy with azithromycin is only advised if a Chlamydia trachomatis coinfection is suspected or diagnosed [6]. Since it is uncertain whether dual therapy has additional benefit in the control of antimicrobial resistance compared with monotherapy, the Dutch STI guideline recommends monotherapy with an intramuscular dose of a third-generation cephalosporin [7]. In 2004, the Dutch STI guideline recommended intramuscular cefotaxime as gonorrhoea treatment in general practice. Few cases of ceftriaxone-resistant gonococcal strains have been identified [8, 9]
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