International Notes
Spectinomycin-Resistant B-Lactamase-Producing
Neisseria gonorrhoeae--England
Spectinomycin-resistant B-lactamase-producing strains of
Neisseria
gonorrhoeae have been isolated from a female, aged 23 years, and a
male, aged 29 years, after treatment failure (ampicillin/probenecid
followed by spectinomycin), although original isolates were found
to
be sensitive by disc tests. Both patients acquired the infection
in
London but are not known to be connected. The consort of the first
case was traced and treated without development of spectinomycin
resistance. Plasmid analysis of the strains showed that both
carried
Asian type plasmids.
Reported by Communicable Disease Report (London). 1982;32:31.
Editorial Note
Editorial Note: Spectinomycin has been the recommended therapy for
persons who have penicillinase producing N. gonorrhoeae (PPNG)
infections and for those who have failed to respond to gonorrhea
treatment (1). The first of two cases of spectinomycin-resistant
PPNG
identified in 1981 was reported to CDC by the United States Air
Force
in California in April 1981 (2). The Air Force conducted an
intensive
investigation overseas for additional cases related to this initial
case; none was identified. The second case was identified in
London
in November 1981 (3). The 1981 cases and the two recent cases
reported above have not been epidemiologically connected.
Spectinomycin-resistant gonococci are uncommon; the total
number
of reported cases is now eight, four with PPNG and four with
non-PPNG.
CDC continues to advise that all gonococcal isolates be tested for
penicillinase production and that PPNG isolates be tested for
spectinomycin resistance (4). Procedures for a provisional
disc-diffusion technique are available (5). All
spectinomycin-resistant gonococcal isolates should be forwarded to
CDC
through state health department laboratories; surveillance is
essential to describe the distribution and trends of
spectinomycin-resistant PPNG. For such cases, the recommended
alternative therapies are: cefoxitin 2g intramuscularly (IM) plus
probenecid 1g orally or cefotaxime 1g IM (2).
Easmon CSF, Ison CA, Bellinger CM, Harris JW. Emergence of
resistance after spectinomycin treatment for gonorrhoea due to
B-lactamase-producing strain of Neisseria gonorrhoeae. Br Med
J
1982;284:1604-5.
Biddle JW, Swenson JM, Thornsberry C. Disc agar diffusion
antimicrobial susceptibility tests with beta-lactamase
producing
Neisseria gonorrhoeae. J Antibiot (Tokyo) 1978;31:352-8.
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