Cephalosporin and azithromycin resistance in Neisseria gonorrhoeae

Decreased susceptibility and resistance to first-line antibiotics have emerged in Neisseria gonorrhoeae worldwide, and resistance to broad-spectrum cephalosporins and azithromycin has raised special concerns. There have been many reports about high-level resistance to broad-spectrum cephalosporins and azithromycin in many regions, which raises alarms about combination therapy of gonorrhea. Mechanisms of drug resistance in Neisseria gonorrhoeae are extremely complex, mainly involving alterations in target sites of antibiotics, as well as decreased influx and increased efflux of antibiotics. These mechanisms depend on or synergize with each other to some extents. In-depth exploration into drug resistance in Neisseria gonorrhoeae may contribute to rational use of antibiotics in clinic and delay in the process of drug resistance. Key words: Neisseria gonorrhoeae; Gonorrhea; Cephalosporins; Drug resistance; Azithromycin