O25 Use of ceftriaxone and doxycycline when treating gonorrhoea: is it prescribed appropriately?. (18th May 2015)

• Record Type: Journal Article
• Authors: Were, John; Town, Katy; Mohammed, Hamish; Saunders, John; Chisholm, Stephanie; Fifer, Helen; Hughes, Gwenda
• Is Part Of: Sexually transmitted infections. Volume 91(2015)Supplement 1
• Page Start: A9
• Page End: A9
• Publication Date: 2015-05-18
• Subjects: Sexually transmitted diseases -- Periodicals; HIV infections -- Periodicals; 616.951005
• DOI: 10.1136/sextrans-2015-052126.25
• Languages: English
• ISSNs: 1368-4973

Abstract

Abstract : Background: National gonorrhoea treatment guidelines recommend ceftriaxone with azithromycin as first-line therapy, but doxycycline is recommended instead of azithromycin for patients with gonococcal pelvic inflammatory disease (PID). In 2013, 86.5% of patients in the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) were treated with the recommended therapy, but 3.9% were treated with doxycycline instead of azithromycin. Objectives: The objective of this analysis was to determine whether ceftriaxone plus doxycycline were prescribed for appropriate indications. Methods: Using GRASP 2013 data, patients prescribed the recommended therapy were compared with patients prescribed ceftriaxone and doxycycline, and associations were assessed using univariate and multivariate logistic regression. Results: In 2013, of the 913 patients prescribed ceftriaxone and azithromycin, 45.9% were men who have sex with men (MSM), 20% were women and 34.1% were heterosexual men while, of the 45 patients prescribed ceftriaxone and doxycycline, 64.4% were MSM, 28.9% were women and 6.7% were heterosexual men (p = 0.001). Of those prescribed ceftriaxone and doxycycline, 22.2% were MSM with chlamydia co-infection and 17.7% were women with PID. On multivariate analysis, MSM co-infected with chlamydia (aOR 3.4, 95% CI, 2.5–4.6; p = 0.001) and women diagnosed with gonococcal PID (OR, 144.8, 95% CI, 24.2–864.0; p < 0.001) were more likely to be prescribed ceftriaxone and doxycycline. Conclusion: Less than a fifth of prescriptions for ceftriaxone with doxycycline were issued to treat gonococcal PID. Use of ceftriaxone with doxycycline may be preferred to treat MSM co-infected with chlamydia by some clinicians. However, as levels of tetracycline resistance in gonorrhoea are high, this may not provide the dual treatment coverage required.