Quinolone resistance in Neisseria gonorrhoeae

Single-dose oral quinolones have been recommended for gonorrhea treatment since 1989. The antimicrobial resistance surveillance system has detected several outbreaks of quinolone-resistant gonococcal infections (QRNG), and sporadic treatment failures have been reported from high-incidence areas such as southeast Asia. QRNG may result from mutations that cause structural-functional changes in DNA topoisomerase (the quinolone target enzyme) or by changes in antimicrobial transport into the bacteria. QRNG has occurred sporadically in the United States, predominantly in persons with contact to persons in southeast Asia, and has typically occurred as an epiphenomenon in persons who were treated with other regimens. Nevertheless, this entity warrants close monitoring. The emergence of QRNG is probably related to antimicrobial misuse and overuse, in particular long-term suppressive or subtherapeutic doses.