Neisseria gonorrhea, the causative agent of Gonorrhea, has developed antibiotic resistance to the “last-line” Cephalosporin’s, Quinolones and Macrolides which is cause for concern. In Zambia, despite recommendations of discontinued use, Ciprofloxacin is used for treatment. The lack of an active surveillance system, appropriate and structured data management and analysis tools magnifies the problem because resistance patterns cannot be monitored. The study aimed to ascertain effectiveness of Ciprofloxacin a Quinolone in comparison with Ceftriaxone a Cephalosporin, in treatment of Gonorrhea using Susceptibility testing; and to identify possible risk factors associated with resistance.
Study design was parallel non-inferior quasi experimental study. Patients at the University Teaching Hospital with discharge and Gonorrhea symptoms who gave consent, were recruited. Fishers Exact Test for associations was used. Data was analyzed using Ordinal logistic regression as the Susceptibility was at 3 levels; Susceptible, Intermediate or Resistant with an assumed Ordinal nature. Proportionality assumption was checked, and when violated Partial Proportional Odds Model was used instead.
A total of 104 isolates were obtained. The overall proportion of patients who had Susceptible, Intermediate and Resistant results were: 49 (47.1%), 55 (52.9%) and 0 (0) for Ceftriaxone and 70 (68.0%), 10 (9.7%) and 22 (22.3%) for Ciprofloxacin respectively. Adjusted estimates in partial Proportional Odds model showed that, Males were 4.1 (95% CI; 1.8, 9.4, p-value=0.001) times more likely to have Intermediate or Susceptible results compared to Resistance than females, or they were more likely to have Susceptible compared to Resistance or Intermediate result compared to females. Ciprofloxacin was 70% less likely than Ceftriaxone of having susceptible or intermediate results compared to resistance and this could be as high as 90% and as high as 40% p-values <0.001).
Level of Ciprofloxacin resistance detected from the Susceptibility testing, shows it is not an effective treatment for Gonorrhea. Ceftriaxone remains a satisfactory option for first-line treatment of Gonorrhea at UTH. Risk factors identified to be associated with resistance in this study were being female and use of Ciprofloxacin.
Ethical clearance was obtained from University of Zambia Biomedical Ethics Research Committee (UNZABREC Ref # 033-06-17).