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Chapter: Microbiology and Immunology: Bacteriology: Neisseria

Treatment of Neisseria gonorrhoeae infection

Sulfonamides were used as early as in 1935 for treatment of gonorrhea. In the beginning, all the strains of gono-cocci were sensitive to sulfonamides but subsequently, they developed resistance to these antibiotics.

Treatment

Sulfonamides were used as early as in 1935 for treatment of gonorrhea. In the beginning, all the strains of gono-cocci were sensitive to sulfonamides but subsequently, they developed resistance to these antibiotics. Penicillin is the drug of choice for penicillin-sensitive strains of N. gonorrhoeae.

Penicillin-resistant strains of N. gonorrhoeae:Initially, gono-cocci were highly sensitive to penicillin (minimal inhibitory con-centration, or MIC, 0.005 U/mL). However, since 1957, strains of gonococci with decreased sensitivity (MIC .0.1 U/mL) to penicillin have been documented. The concentration of peni-cillin required to inhibit the growth of gonococci has increased by many folds and is now considerably higher (2.4–4.8 MU).

·           Most of them are beta-lactamase (penicillinase) producing by the virtue of plasmid transmission. These strains show high level of resistance to penicillin.

·            Some strains of N. gonorrhoeae not producing beta-lactamase but yet showing resistance to penicillin have also been reported. This resistance is mediated chromosomally and is of low level.

Resistance to other antibiotics: Chromosomal-mediatedresistance to other antibiotics, such as tetracycline, erythromy-cin, and aminoglycosides, has also been reported.

·           Tetracyclines are no longer given for gonococcal infection because of the prevalence of tetracycline resistance.

·           Resistance to ciprofloxacin has also been increasingly docu-mented in Southeast Asia, Africa, and Australia.


      Immediate saline irrigation and intravenous ceftriaxone are effective for treatment of gonococcal conjunctivitis. Local application of 0.5% of erythromycin ophthalmic ointment or 1% tetracycline or 1% silver nitrate ointment is effective for treatment of gonococcal ophthalmia neonatorum.

PID as such is a mixed infection of gonococci, Chlamydia, and other facultative anaerobic pathogens. The treatment, therefore, is by broad-spectrum antibiotics to cover all infect-ing organisms.


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