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May 15, 2013

Cephalosporin Resistance in Neisseria gonorrhoeae Infections—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: Public Health Ontario, Toronto, Canada (Drs Allen and Melano) (vanessa.allen@oahpp.ca); and Mt Sinai Hospital, Toronto, Ontario, Canada (Dr Low).

JAMA. 2013;309(19):1989-1991. doi:10.1001/jama.2013.4087

In Reply: Drs Klausner and Kerndt highlight the urgent need for innovative approaches to address the continued emergence of multidrug-resistant N gonorrhoeae. Specifically, by analogy to efforts successful at reducing macrolide-resistant group A streptococci, they suggest real-time detection and antimicrobial testing use may turn the tide of cephalosporin resistance in N gonorrhoeae.

Point-of-care diagnostics that enable the detection of gonorrhea and markers of antibiotic resistance are feasible and offer great promise in facilitating public health control of gonorrhea, including slowing the development of cephalosporin resistance. However, evidence that the introduction of these tests would reverse preexisting levels of cephalosporin resistance in N gonorrhoeae is less certain. Once established, preexisting rates of resistance to antibiotics tend to persist in N gonorrhoeae.