TITLE:
Detection and Identification of Gonococci Resistance to Cephalosporin and Determination the Most Effective Empirical Treatment for Gonococcal Urethritis in Male Human in Egypt
AUTHORS:
Somaih H. Mohammed, Mohmed E. A. Dawoud, Mohsen H. Attia
KEYWORDS:
Gonorrhoea, Urethritis, Gonococcal Urethritis, Sexually Transmitted Diseases, Resistance to Antibiotics in Human Gonococcal Urethritis in Male in Egypt, Resistance to Cephalosporins, Resistance to Ceftriaxone, Empirical Treatment for Gonococcal Urethriti, Niesseria gonorrhoeae
JOURNAL NAME:
Open Journal of Medical Microbiology,
Vol.12 No.4,
December
30,
2022
ABSTRACT: Introduction: Gonorrhoeae and antimicrobial
resistance AMR of gonococci is a major health problem today, because emerged resistance
to last line empirical treatment for gonorrhoeae cephalosporins in many countries is predictable to be untreatable disease in near future. WHO GASP, WHO GLASS and WHO’s global action plan on AMR recommends to expand nationally and internationally to collect data
to monitor AMR of gonococci for public health policies. Objective: Our
aim is to detect resistance of gonococci to Cepha- losporins and determine the most effective empirical treatment for un-com- plicated gonococcal urethritis in males in Egypt. Methods: We
depended in our methodology on selected gonococci from male urethral discharge
specimens on Thyer Martien medium; collected
33 isolates during three years from 2017 to 2020; used antibiotics with MIC according to international standards and measuring IZD according to antimicrobial susceptibility testing
reference ranges in international standards. Results: By statistical
studies, resistance to cephalosporins was as follows: Cephradine 97%, Cefaclor
87.9%, Cefoxitin 97%, Ceftriaxone 90.9% and 42.4% to Cefepime, that shows
hetero-genecity in resistance inside cephalosporin group; while resistance to
Macrolides group represented by Azithromycin
and Tetracyclins group represented by Doxycycline was as follows:
Azithromycin 39.4%, Doxycycilne 27.3%; finally fluoroquinolones, the most effective
group, resistance, was as: Levofloxacin 15.2%, Ciprofloxacin
15.2% and Ofloxacin 24.2%. Conclusion: The most effective empirical treatment for uncomplicated gonococcal urethritis in males in EGYPT is Fluoroquinolone; especially Levofloxacin ranks first susceptibility as 78.8% and 15.2%
resistance followed by Ciprofloxacin susceptibility as 69.7% and 15.2%
resistance, finally Ofloxacin susceptibility as 66.7% and 24.2% resistance; for Ceftriaxone not more recommended in EGYPT as empirical treatment for
uncomplicated gonococcal urethritis, it is susceptibility as 6.1% and 90.9%
resistance; in addition, we can use combination therapy of
Fluoroquinolones with Azithromycin or Doxycycline, whose susceptibility is 30.3% for Azithromycin and 42.4% for
Doxycycycline, while resistance is 39.4% for Azithromycin and 27.3% for
Doxycycline. It is worth noting that only Cefepime in Cephalosporins group
represents 42.4% susceptibility and 42.4% resistance; in addition to the Carbapenems group, it represents as 42.4% susceptibility for Imipenem and 45.5% resistance, then 42.2% susceptibility for Meropenem and 48.5% resistance, which can
play role in combination therapy.