Widespread Use of High-Dose Ceftriaxone Therapy for Uncomplicated Gonorrhea Without Reported Ceftriaxone Treatment Failure: Results From 5-Year Multicenter-Surveillance Data in China

Abstract

Abstract Background Antimicrobial resistance (AMR) to N gonorrhoeae has emerged for each of the antibiotics following their introduction into clinical practice recommended as first-line therapies. To improve rational and effective clinical antibiotic treatment, we analyzed the prescription patterns of antibiotics and its therapeutic effect in the treatment of uncomplicated gonorrhea in China. Methods We obtained data from a follow-up multicenter surveillance program. Multinomial logistic regression analyses were conducted to explore the associations between demographic/clinical variables with the levels of sensitivity to ceftriaxone and prescription of high-dose ceftriaxone. Results In this study, 1,686 patients infected with N gonorrhoeae were recruited in a surveillance network during the period of January 1, 2013, through December 31, 2017, in seven hospitals distributed in five provinces. The prevalence of isolates with decreased susceptibility to ceftriaxone was 9.8% (131/1333), fluctuating between 5.6% and 12.1%. Injectable ceftriaxone was chosen as the first-line treatment among 83.1% patients, and most of them (72.7%, 1,018/1,401) received more than a 1,000-mg dosage. Patients who were infected with gonorrhea or infected with other STDs before (AOR 1.611, 95% CI [1.103-2.352]; AOR 2.329, 95% CI [1.553-3.494]) or who used already antibiotics for this infection (AOR 1.597, 95% CI [1.04-2.452]) were associated with higher prescribed ceftriaxone dosage prescribed. All of the patients recruited in this study were cured regardless of the isolates’ susceptibility to ceftriaxone or the dosage of ceftriaxone they received. Conclusions No failure treatment for uncomplicated gonorrhea was reported in China; however, high-dose ceftriaxone was widely used in China, and its impacts need further studies.