Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.
Sex Transm Dis. 2018 Sep;45(9):600-606. doi: 10.1097/OLQ.0000000000000819.
Provider adherence to the national treatment guidelines for gonorrhea is critical to assuring effective treatment. It is also an important means of limiting antibiotic overuse, which can lead to development of resistant bacteria. The Chinese treatment guidelines recommend the monotherapy with ceftriaxone or spectinomycin in accordance with the World Health Organization guidelines for treatment of uncomplicated gonorrhea. We evaluated adherence to the guidelines among treatment providers in China.
The study was a nationwide cross-sectional study. In each of the 6 geographic regions in China, at least 1 province was selected. In each selected province, cities with elevated incidence of reported gonorrhea were purposively selected. Using a questionnaire, 2121 physicians recruited from 512 different categories and levels of health sectors from July to September 2017 were investigated.
Of the participants, more than 99% diagnosed gonorrhea using one of the laboratory tests including Gram stain, culture, nucleic acid amplification test, or other tests. Culture was the predominant assay of the choice for the diagnosis. Of the 1890 physicians who provided information on prescription behaviors, 62.2% were not adherent to the regimens for treatment of uncomplicated gonorrhea recommended by the National Sexually Transmitted Disease (STD) Treatment Guidelines (National STD Guidelines). Physicians working in the areas located in Northern China (adjusted odds ratio [AOR], 3.06; 95% confidence intervals [CIs], 1.77-5.31), in general hospitals or departments of urology (AOR, 1.54; 95% CIs, 1.08-2.19), diagnosing more cases in the past 6 months (AOR, 1.82; 95% CIs, 1.25-2.67), or unfamiliar with the treatment regimens in the National STD Guidelines (AOR, 3.48; 95% CIs, 2.76-4.37) were significantly more likely to be nonadherent to the National STD Guidelines.
It can be concluded from our study that nonadherence to the national guidelines and empirical treatment with high doses of ceftriaxone occurred frequently in China. Further studies on the impacts of the empirical treatment on antimicrobial resistance of gonorrhea are needed.
提供者遵守淋病国家治疗指南对于确保有效治疗至关重要。这也是限制抗生素过度使用的重要手段，因为抗生素过度使用可能导致耐药细菌的产生。中国的治疗指南建议根据世界卫生组织治疗单纯性淋病的指南，采用头孢曲松或壮观霉素单药治疗。我们评估了中国治疗提供者对指南的遵守情况。
本研究为全国性横断面研究。在中国的 6 个地理区域中，每个区域至少选择一个省份。在每个选定的省份中，选择淋病报告发病率较高的城市。2017 年 7 月至 9 月期间，通过问卷调查，对来自 512 个不同类别和级别的卫生部门的 2121 名医生进行了调查。
在参与者中，超过 99%的人使用包括革兰氏染色、培养、核酸扩增试验或其他试验在内的一种实验室检测方法诊断淋病。培养是诊断淋病的主要检测方法。在 1890 名提供处方行为信息的医生中，62.2%的医生不遵守国家性传播疾病（STD）治疗指南（国家 STD 指南）推荐的单纯性淋病治疗方案。来自北部中国地区（调整后的优势比[OR]，3.06；95%置信区间[CI]，1.77-5.31）、综合医院或泌尿科的医生（OR，1.54；95%CI，1.08-2.19）、过去 6 个月诊断更多病例的医生（OR，1.82；95%CI，1.25-2.67）或不熟悉国家 STD 指南治疗方案的医生（OR，3.48；95%CI，2.76-4.37）更有可能不遵守国家 STD 指南。
从我们的研究可以得出结论，中国经常出现不遵守国家指南和经验性使用大剂量头孢曲松的情况。需要进一步研究经验性治疗对淋病抗菌药物耐药性的影响。
