g. Belarus. Wortmannin This may indicate that penicillins have not been widely used for treatment of gonorrhoea in many years and or that no imported B lactamase producing gonococcal strains have been established and resulted in an endemic spread in Russia during several years. The prevalence of resistance to azithromycin was also high, particularly during the latest years, that is, 16 17% in 2011 2012. Inhibitors,Modulators,Libraries However, no isolates with high level resistance to azithromycin (MIC 256 mg L which have been described from several other countries, have yet been identified in Russia. Worryingly, gonococcal isolates with resistance to spectinomycin, which are exceedingly rare internationally, were identified in all the surveyed years and in four of the seven Federal Districts of Russia.
In earlier Russian studies, spectinomycin resistant gonococcal isolates have also been found in all the seven Federal Districts of Russia. In the present study, the spectinomycin resistant isolates Inhibitors,Modulators,Libraries (n _ 50 belonged to 32 different STs. Accordingly, they did not represent any clonal spread and spectinomycin resistance has been selected in many different gonococcal strains. Spectinomycin remains also available and used for treatment of gonorrhoea in Russia, that is, despite that the level of use has decreased substantially during the last two decades. Fortunately, the resistant isolates had a spectinomycin MIC of maximum 128 256 mg L and no isolates with high level resistance to spectinomycin (MIC 1024 mg L have yet been found in Russia.
The molecular mechanisms for this low level resistance to spectinomycin are commonly specific amino acid alterations in the ribosomal protein S5, which has been selected by frequent use of spectinomycin. Using the CLSI breakpoints, all isolates from 2009 to Inhibitors,Modulators,Libraries 2012 were susceptible to ceftriaxone (MIC 0. 25 mg L. However, using the European EUCAST breakpoint were resistant to ceftriaxone (MIC 0. 125 mg L. Interestingly, the prevalence of these ceftriaxone resistant isolates decreased significantly Inhibitors,Modulators,Libraries (P 0. 05 i. e. from 4. 0% in 2009 to 0% in 2012. Still no treatment failure of gonorrhoea with ceftriaxone has been verified in Russia, however, isolates with a ceftriaxone MIC of 0. 25 mg L have resulted in failures to treat pharyngeal gonorrhoea with ceftriaxone in other countries.
Similar Inhibitors,Modulators,Libraries increases in the susceptibility to extended spectrum cephalosporins such as cefixime and ceftriaxone have recently been reported from the United Kingdom, Slovenia and India. The reasons for this remain unknown, however, this might indicate that mostly appropriate treatment with ceftriaxone (in adequately high dose and quality with or without additional azithromycin (in dual therapy regimens http://www.selleckchem.com/products/SB-203580.html are used for treatment of gonorrhoea internationally. Accordingly, the use of less potent antimicrobials for treatment might have decreased.