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Volume 11, Number 8—August 2005

Research

Optimizing Treatment of Antimicrobial-resistant Neisseria gonorrhoeae

Kakoli Roy*Comments to Author , Susan A. Wang*, and Martin I. Meltzer*
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Main Article

Table 1

Strategies modeled

Strategy (ST) Brief description Detailed description
ST1 Ciprofloxacin + culture tests + ciprofloxacin susceptibility tests Prescribe ciprofloxacin to symptomatic patients and culture test all patients. Test 80% of all positive specimens for ciprofloxacin resistance. Recall and treat asymptomatic gonorrhea patients and patients with ciprofloxacin-resistant strains.
ST2* Ciprofloxacin + nonculture tests Prescribe ciprofloxacin to symptomatic patients and use nonculture tests on all patients. Recall and treat positive asymptomatic gonorrhea patients.
ST3 Ceftriaxone + culture tests + ceftriaxone susceptibility tests Prescribe ceftriaxone to symptomatic patients and culture test all patients. Recall and treat asymptomatic gonorrhea patients. Test 20% of positive isolates for resistance to cephalosporin.
ST4* Ceftriaxone + nonculture tests Prescribe ceftriaxone to symptomatic patients and use nonculture tests on all patients. Recall and treat asymptomatic gonorrhea patients.

*Since ST2 and ST4 do not use culture-based testing, no antimicrobial susceptibility tests are assumed to be associated with these strategies.

Main Article

1In 2000, only 18% of gonorrhea tests performed by public health laboratories in the United States were culture-based tests.

2Monte Carlo simulation involves specifying a probability distribution of values for model inputs. A computer algorithm then runs the model for several iterations. During each iteration, the computer algorithm selects input values from the probability distributions, and calculates the output (e.g., cost per patient successfully treated). After the final run, the model provides results such as the mean, median, and 5th and 95th percentiles for each specified output.

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