A randomized trial of ciprofloxacin versus cefixime for treatment of gonorrhea after rapid emergence of gonococcal ciprofloxacin resistance in the Philippines

From 1994 through 1996-1997, high-level ciprofloxacin resistance (minimum i nhibitory concentration [MIC], greater than or equal to4.0 mug/mL) increase d from 9% to 49% of gonococcal isolates recovered from consecutive female s ex workers in Cebu and Manila, The Philippines (P < .01). During 1996-1997, 105 female sex workers with gonorrhea were prospectively randomized to rec eive treatment with oral ciprofloxacin, 500 mg, or cefixime, 400 mg, and fo llowed for test of cure. Neisseria gonorrhoeae was reisolated within 28 day s after treatment from 1 (3.8%) of 26 women given cefixime versus 24 (32.3% ) of 72 women given ciprofloxacin (P < .01). Treatment failure (reisolation of pretreatment auxotype/serovar) occurred in 14 (46.7%) of 30 women infec ted with strains with MICs of ciprofloxacin greater than or equal to4.0 mug /mL versus 1 (3.6%) of 28 infected by strains with MICs <4.0 <mu>g/mL (P < .01). High-level, clinically significant gonococcal resistance to ciproflox acin has rapidly emerged in The Philippines, and spread of fluoroquinolone resistance through commercial sex poses a threat to control of gonorrhea an d prevention of human immunodeficiency virus infection and the acquired imm unodeficiency syndrome.