Faced with evidence that drug-resistant gonorrhea is spreading in the province, Ontario is recommending a different treatment approach for the sexually transmitted infection.
New treatment guidelines recommend that doctors no longer use the established therapy, a last oral antibiotic that could be used solo against the infection. Instead, Public Health Ontario is recommending that people who test positive for gonorrhea should be treated with a combination of an injectable antibiotic plus a second antibiotic, which comes in pill form.
Dr. Vanessa Allen of the provincial public health agency co-chaired the committee that developed the new treatment guidelines. She said using a combination of antibiotics may help to slow gonorrhea’s relentless march through the antibiotics in medicine’s armamentarium.
“It’s really too bad that we can no longer use the pill (alone),” Allen said in an interview.
“If we could, obviously we would want to offer that. ... (But) we know it’s not as effective ... and it may in fact be promoting resistance in these organisms in the community.”
In adopting the combination therapy — injectable ceftriaxone and oral azithromycin — Ontario is falling into line with the U.S. Centers for Disease Control, Public Health England and the European Centre for Disease Control, all of which recommend this regimen as the first-line treatment for gonorrhea. Those recommendations were made in the face of the spread of a resistant clone of gonorrhea which has been making its way around the globe.
But it makes Ontario the first Canadian jurisdiction to go this route. Currently the first-line therapy for gonorrhea in the rest of the country remains a single dose of the oral drug cefixime.
The Public Health Agency of Canada is in the process of revising the national treatment guidelines for gonorrhea and is expected to release its new recommendations sometime this year. In late 2012 the agency published interim recommendations that included urging doctors to double the dose of antibiotics used — either injected ceftriaxone or oral cefixime — to reduce the risk that the treatment would fail to cure the infection.