Dickson C, et al. – Authors sought to assess adherence with first–line gonorrhoea treatment recommendations in Ontario, Canada, following recent guideline changes due to antibiotic resistance. Concerns regarding antibiotic resistance highlighted the necessity for regularly updating gonorrhoea treatment guidelines and rapidly adopting them in practice. Findings suggested poor adherence following dissemination of updated guidelines. Over a year after the latest Ontario guidelines were released, there were 40% of patients who did not receive first–line treatment, that put them at risk of treatment failure and potentially promoted further drug resistance. They suggest devoting greater attention to dissemination and implementation of new guidelines.

Methods

• Interrupted times–series analyses were used to assess treatment data for cases of uncomplicated gonorrhoea reported in Ontario, Canada, between January 2006 and May 2014.
• Adherence with first–line treatment according to the guidelines in place at the time and the use of specific antibiotics over time were determined.
• The introduction of new recommendations in the Canadian Guidelines for Sexually Transmitted Infections in 2008 and 2011 and the release of the province of Ontario’s Guidelines for the Treatment and Management of Gonococcal Infections in Ontario in 2013 were used as interruptions in the time–series analysis.

Results

• Overall, there were reports of 34 287 gonorrhoea cases between 1 January 2006 and 31 May 2014.
• 32 312 (94.2%) patients had their treatment data available.
• 32 272 (94.1%) cases without either a conjunctival or disseminated infection were analyzed.
• Following the release of the 2011 recommendations, there appeared an immediate decrease below 30% in adherence with first–line recommendations.
• A slow increase in adherence was observed but it did not reach baseline levels before the 2013 guidelines were released.
• Following release of the 2013 guidelines, researchers observed a decrease in adherence again; adherence seemed slowly recovering but by May 2014, was only approximately 60%.