Agency Urges Change in Antibiotics for Gonorrhea

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.