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Table 1 Characteristics of verified gonorrhoea treatment failures with ceftriaxone (250–1000 mg × 1) and causing gonococcal strain

From: Current and future antimicrobial treatment of gonorrhoea – the rapidly evolving Neisseria gonorrhoeae continues to challenge

Country, year Ceftriaxone Therapy Ceftriaxone MIC (mg/L) fT>MIC, hoursa MLST/NG-MAST Site of failure Final successful treatment
Australia (n = 2), 2007 [31] 250 mg × 1 0.016-0.03 (Agar dilution) 41.4-50.3 ND/ST5, ST2740 Pharynx Ceftriaxone 500 mg × 1/ Ceftriaxone 1 g × 1
Japan (n = 1), 2009 [30] 1 g × 1 4.0b (Etest, XDR) 0 ST7363/ST4220 Pharynx Nonec
Sweden (n = 1), 2010 [34] 250 mg × 1 and 500 mg × 1 0.125-0.25b (Etest) 15.6-32.8 ST1901/ST2958 Pharynx Ceftriaxone 1 g × 1
Australia (n = 1), 2010 [32] 500 mg × 1 0.03-0.06 (Agar dilution) 41.3-49.9 ND/ST1407, ST4950 (genogroup 1407) Pharynx Azithromycin 2 g × 1
Slovenia (n = 1), 2011 [36] 250 mg × 1 0.125b (Etest) 24.3 ST1901/ST1407 (genogroup 1407) Pharynx Ceftriaxone 250 mg × 1 plus azithromycin 1 g × 1
Australia (n = 2), 2011 [33] 500 mg × 1 0.03-0.06 (Agar dilution) 41.3-49.9 ST1901/ST225, new variant of ST225 Pharynx Ceftriaxone 1 g × 1 plus azithromycin 2 g × 1 or Ceftriaxone 1 g × 1
Sweden (n = 3), 2013–2014 [35] 500 mg × 1 0.064-0.125b (Etest) 32.8-41.3 ST1901/ST3149, ST3149, ST4706 (genogroup 1407) Pharynx Ceftriaxone 1 g × 1
  1. aSimulation of time of free ceftriaxone above MIC (fT>MIC) based on mean pharmacokinetic parameter values. Data from Chisholm et al. [52]
  2. bGenetic cephalosporin resistance determinants (penA, mtrR, penB) elucidated [3, 58]
  3. cThe infection was considered to have resolved spontaneously within 3 months
  4. MIC minimum inhibitory concentration, MLST multilocus sequence typing, NG-MAST Neisseria gonorrhoeae multi-antigen sequence typing, ND not determined, ST sequence type, XDR extensively drug-resistant [9]