Roy Kakoli, Wang Susan A, Meltzer Martin I
Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Emerg Infect Dis. 2005 Aug;11(8):1265-73. doi: 10.3201/eid1108.050157.
The increasing prevalence of ciprofloxacin-resistant Neisseria gonorrhoeae has required replacing inexpensive oral ciprofloxacin treatment with more expensive injectable ceftriaxone. Further, monitoring antimicrobial resistance requires culture testing, but nonculture gonorrhea tests are rapidly replacing culture. Since the strategies were similar in effectiveness (> 99%), we evaluated, from the healthcare system perspective, cost-minimizing strategies for both diagnosis (culture followed by antimicrobial susceptibility tests versus nonculture-based tests) and treatment (ciprofloxacin versus ceftriaxone) of gonorrhea in women. Our results indicate that switching from ciprofloxacin to ceftriaxone is cost-minimizing (i.e., optimal) when the prevalence of gonorrhea is > 3% and prevalence of ciprofloxacin resistance is > 5%. Similarly, culture-based testing and susceptibility surveillance are optimal when the prevalence of gonorrhea is < 13%; nonculture-based testing is optimal (cost-minimizing) when gonorrhea prevalence is > or = 13%.
耐环丙沙星淋病奈瑟菌的患病率不断上升，这就需要用更昂贵的注射用头孢曲松来取代廉价的口服环丙沙星治疗。此外，监测抗菌药物耐药性需要进行培养检测，但非培养淋病检测正在迅速取代培养检测。由于这些策略在有效性方面相似（>99%），我们从医疗保健系统的角度评估了女性淋病诊断（培养后进行抗菌药物敏感性试验与基于非培养的检测）和治疗（环丙沙星与头孢曲松）的成本最小化策略。我们的结果表明，当淋病患病率>3%且环丙沙星耐药率>5%时，从环丙沙星改用头孢曲松可使成本最小化（即最优）。同样，当淋病患病率<13%时，基于培养的检测和药敏监测是最优的；当淋病患病率≥13%时，基于非培养的检测是最优的（成本最小化）。
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