JOURNAL READING

By: Consulent:
Nickolas Enriyo Jayabrata dr. Arum Krismi, M.Sc,
42170176 Sp.KK
 background
• Gonorrhea is the second most commonly reported notifiable disease in the
United States, with an estimated 820,000 new gonococcal infections
occurring each year.
• The first-line recommended regimen  change over time, due to the emergence
of antimicrobial resistance.
• the Centers for Disease Control and Prevention (CDC) from 1993 to 2010
Ceftriaxone
Cefixime as the first-line regimen for treatment of
uncomplicated gonococcal infections of the
Ciprofloxacin
cervix, urethra, or rectum in adolescents and
Ofloxacin
adults
Levofloxacin
background (cont.)
• 2010  dual therapy
ceftriaxone or cefixime + azithromycin or doxycycline
(resistance of cephalosporins)
• 2012  dual therapy
ceftriaxone + azithromycin or doxycycline
(cefixime was no longer recommended as a first-line regimen)
• 2015 till this study published  dual therapy
ceftriaxone + azithromycin
background (cont.)
In the context of rapidly changing recommendations for management of
uncomplicated gonorrhea in the past decade, they assessed primary care
physicians knowledge of the first-line recommended regimen for treating
uncomplicated urogenital gonorrhea using ceftriaxone and azithromycin
dual therapy as opposed to monotherapy with ceftriaxone or azithromycin.
FYI
methods
• The data were collected through the DocStyles Web-based survey.
• A random sample of physicians was selected to match the American
Medical Association's Masterfile of licensed US physicians for age,
gender, and region.
• The 2015 survey included questions on counseling, screening, alcohol,
physical activity, hypertension, human papillomavirus, human
immunodeficiency virus, and sexually transmitted diseases (STDs).
• Porter Novelli Public Services (www.porternovelli.com) conducted the
survey from June 4 to June 23, 2015. Of the 1794 physicians sampled,
1500 (84%) completed the survey.
analysis
“Which of the following regimens is the best option in the case of an
18-year-old man with gonococcal urethritis?”

• single dose ceftriaxone 250 mg intramuscularly

• single dose azithromycin 1.0 g orally
• both of these
• single dose spectinomycin 2.0 g intramuscularly plus levofloxacin 500
mg orally for 7 days.
• not sure
analysis
Other variables analyzed
• physician specialty
• physician gender
• years in practice
• physician age
• number of practitioners in practice
• practice region
• estimated financial situation of the majority of patients in the respondent's
practice
• sources used to pursue CME in the past year (journals, medical podcasts,
government health agencies like CDC or National Institutes of Health,
conferences, internet sites, classes, CD-ROM).
disscusion
• Physician knowledge of the recommended regimen for treating
uncomplicated urogenital gonorrhea using ceftriaxone and
azithromycin dual therapy decreased with increasing years of provider
practice and with higher socioeconomic status of patients.
• Knowledge of the recommended dual therapy was higher among
physicians who reported using journals, podcasts, and government
agencies for pursuing CME.
disscusion
• Among gonorrhea cases reported by providers (STD clinics,
hospital/emergency departments, family planning and reproductive
health, private provider, public clinic) to the STD Surveillance Network,
use of dual therapy with ceftriaxone plus azithromycin or doxycycline
increased from 34% in 2010 to 65% in 2012.
• Use of ceftriaxone plus either azithromycin or doxycycline increased
from 61%to 81%for cases reported by CDPH providers (93% of these
caseswere reported by STD clinics) and from 55%to 59% for those from
non-CDPH providers (eg, hospitals, community health centers, private
providers).
disscusion
• This study helps elucidate factors that are associated with physician
knowledge of the recommended regimen for treating gonorrhea. Potential
barriers to guideline adherence include lack of awareness, lack of familiarity,
lack of agreement, and inertia of previous practice.
• Further research is needed for identifying underlying reasons for variation in
physician knowledge with years in practice, socioeconomic status of patients,
and source used for pursuing CME, including understanding of the rationale
for dual therapy and the determinants of physician choice.
• Research is also needed on the use of other regimens for gonorrhea
treatment.
• It is important to enhance physician understanding of and compliance with
dual therapy for gonorrhea, due to concerns about emergence of
antimicrobial resistance.
reflections
thankyou.