In July 2002, Wyeth Pharmaceuticals (Collegeville, Pennsylvania) discontinued manufacturing cefixime (Suprax[R]) in the United States. In October 2002, the company ceased marketing cefixime tablets (200 mg and 400 mg) because of depletion of company inventory. Wyeth's patent for cefixime expired on November 10, 2002. No other pharmaceutical company manufactures or sells cefixime tablets in the United States. Wyeth will continue to sell cefixime suspension (100 mg/5 ml) until March 31, 2003, or until company inventory is depleted, whichever is sooner.
Cefixime is the only CDC-recommended oral antimicrobial agent to which Neisseria gonorrhoeae has not developed significant resistance (1). Uncomplicated N. gonorrhoeae infections may be treated with single-dose regimens of cefixime 400 mg orally, ceftriaxone 125 mg intramuscularly, or an oral fluoroquinolone (ciprofloxacin 500 mg, levofloxacin 250 mg, or ofloxacin 400 mg). However, fluoroquinolones should nor be used for treatment of gonorrhea if the infection was acquired in Asia, the Pacific Islands (including Hawaii), or California because the prevalence of fluoroquinolone-resistant N. gonorrhoeae is high in those areas (1,2).
In the absence of cefixime, the primary recommended treatment option for gonorrhea in Hawaii and California is ceftriaxone. Also, in the absence of cefixime, ceftriaxone is the only CDC-recommended gonorrhea treatment option for young children and pregnant women throughout the United States. Fluoroquinolones can continue to be used for treating gonorrhea in areas of the United States with low prevalence of fluoroquinolone-resisrant N gonorrhoeae, but antimicrobial susceptibility monitoring should routinely be performed (2). Other oral antimicrobial agents, such as cefpodoxime, cefuroxime axetil, and azirhromycin, are not recommended by CDC for the treatment of gonorrhea. Additional information on the use of oral antimicrobials in treating N gonorrhoeae infections will be available from CDC at http://www.cdc.gov/std.
(1.) CDC, Guidelines for treatment of sexually transmitted diseases 2002. MMWR 2002;51(No. RR-6).
(2.) CDC. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae--Hawaii and California, 2001. MMWR 2002;51:1041-4.
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