NEW YORK (Reuters Health) - More than 40% of clinical isolates of Neisseria gonorrhea from a clinic in Durban are resistant to ciprofloxacin, the first-line treatment for gonorrhea in South Africa, investigators observe.

According to their report in the October 1st issue of The Lancet, Drs. Prashini Moodley and A. Willem Sturm from the University of KwaZulu Natal in Durban have been testing N. gonorrhea isolates for ciprofloxacin susceptibility since 1995. Until 2002, all isolates were sensitive. After this point, treatment failures began to appear.

In November 2003, 22% of 139 isolates were resistant to ciprofloxacin (minimum inhibitory concentration of 1 mg/L or higher). The rate of resistance rose from 24% in January and February of 2004 to 42% in January and February of 2005.

So far, the National Department of Health in South Africa still recommends ciprofloxacin as first-line treatment for gonorrhea, the authors report, with the only change being that treatment be switched to ceftriaxone in patients with failure after being treated with ciprofloxacin.

Dr. Moodley and Dr. Sturm point out that postponing effective treatment has caused preferential transmission of resistant bacteria, which in turn increases the duration of mucosal inflammation and susceptibility to HIV.

They conclude that "an urgent review of the syndromic management guidelines, with a view to replacing ciprofloxacin as first-line treatment in Durban, KwaZulu Natal, is long overdue."

Lancet 2005;366:1159.

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