Adherence to New Treatment Guidelines for Uncomplicated Anogenital and Pharyngeal Neisseria Gonorrhea Cases in Adults in Alberta, Canada
The emergence of reduced susceptibility of N. gonorrhoeae (NG) to cephalosporins and azithromycin has required the global revision of treatment guidelines. In Alberta, Canada in December 2011, guidelines for preferred treatment were changed from monotherapy with cefixime 400 mg orally or ceftriaxone 125 mg IM to dual therapy with cephalosporins (cefixime 800 mg orally or ceftriaxone 250 mg IM) plus azithromycin 1g. We examined the adherence to new treatment guidelines introduced in 2012 in Alberta, Canada.
Treatment data for provincial NG cases diagnosed between 2010 and 2013 were reviewed. Treatment data was coded as adhering to preferred or alternate guidelines if the case received medication meeting guideline recommendations at that time. Three time periods were created: pre-guideline change, guideline change, and one year post-guideline change.
A total of 6,685 NG cases were diagnosed; 4% (n=267) of cases had no treatment data available. Forty percent (n=2,653) of cases were treated prior to the guideline change, 31.8% (n=2,038) during the first year of change, and 26.9% (n=1,727) cases were treated one year post-change. Overall, 89.3% (n=2,367) of pre-guideline change cases were treated with a recommended treatment regimen; this dropped to 57.6% (n=1,174) during the first year of change, with a return to 85.4% (1,474) one year post-change. Cases treated by a provincial STI Clinic were more likely to be treated according to guidelines than cases treated by other healthcare providers throughout all time periods (P<0.001). Adherence dropped for other healthcare providers from 86.4% pre-guideline change to 41.1% during the first year of guideline change returning to 78.8% one year post-guideline change. During the first year of guideline change, the most common scenarios in which guidelines were not met included the use of cefixime 400 mg orally alone (60.5%; n=523) or cefixime 800 mg orally/ceftriaxone 250 mg IM monotherapy (20.1%, n=174). In addition, 5.4% (n=47) of cases were treated solely for chlamydia and 5.4% (n=47) of cases received a treatment regime containing ciprofloxacin.
One year post-guideline change, the rate of adherence to provincial guidelines for NG treatment returned to rates similar to those prior to guideline change.
N. Anderson, None
R. Read, None
A. Singh, None
P. Smyczek, None
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