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Nonadherence to National Guidelines for Antibiotic Treatment of Uncomplicated Gonorrhea in China: Results From a Nationwide Survey

Han, Yan, PhD*†; Yin, Yue-Ping, PhD*†; Zhou, Ying, MSc; Liu, Jing-Wei, MSc; Zhou, Ke, MSc; Liu, Hong-Ye, MSc; Yi, Fei, MSc; Chen, Xiang-Sheng, MD*†

doi: 10.1097/OLQ.0000000000000819
Original Studies

Background 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.

Methods 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.

Results 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.

Conclusions 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.

A nationwide survey in China found that nonadherence to the national gonorrhea treatment guidelines occurred frequently and resulted in empirical therapy with high doses of ceftriaxone.

From the *National Center for STD Control, Chinese Center for Disease Control and Prevention; and

Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China

Acknowledgments: The authors would like to thank the staff who participated in the study in the health sectors where the surveys took place and the following local coordinators for organizing the local surveys: An Liu, Beijing YouAn Hospital, Capital Medical University; Cai-Yu Mao, Shenzhen Center for Chronic Disease Control; Chuan Wan, Jiangxi Provincial People's Hospital; Cui-ling Ma, Fourth Military Medical University; Dong-Yan Zhang, Jiangning Peoples' Hospital, Jiangsu; Guan-Qun Wang, Anhui Provincial Institute of Dermatology; Hao Cheng, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University; He Wang, Zhongshan Hospital of Xiamen University; Hong-Min Li, Jiangsu Provincial Hospital of Traditional Chinese Medicine; Jian-Qin Wang, Guangzhou Institute of Dermatology; Jie Zhang, Guangxi Autonomous Region Institute of Dermatology; Li-Min Yao, Bethune International Peace Hospital; Ling Sun, Second affiliated Hospital of Dalian Medical University; Liu-Feng Yuan, Being Ditan Hospital, Capital Medical University; Man-Li Qi, Tianjin Medical University General Hospital; Kao-Kao Zhu, Hainan Provincial Skin Disease Hospital and Provincial Center for Skin Diseases and STI Control; Ping-Yu Zhou, Shanghai Skin Disease Hospital; Qi-Le Zheng, First Affiliated Hospital of Fujian Medical University; Sen Yang, First Affiliated Hospital of Anhui Medical University; Shou-Zhi Gao, Hunan Provincial Centre for Disease Control and Prevention; Wan-Yue Zhang, Yunnan Provincial Centre for Disease Control and Prevention; Wei-Yun Li, Tianjing Academy of Traditional Chinese Medicine Affiliated Hospital; Wen-Li Feng, Second Affiliated Hospital of Shanxi Medical University; Xiao-Hua Tao, Dermatology Hospital of Jiangxi Province; Xiao-Hong Su and Qian-Qiu Wang, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College; Xiao Song, Heilongjiang Provincial Institute of Dermatology; Xue Han, Yinchuan Municipal Centre for Disease Control and Prevention; Yong Cui, China-Japan Friendship Hospital; and Yu-Ye Li, First Affiliated Hospital of Kunming Medical University. The authors also appreciate Dr Xiao-Li Yue for providing background data of health facilities to report gonorrhea cases to the national surveillance program and Dr Kumi Smith for providing English editorial assistance.

This study was supported by a grant from the Chinese Academy Medical Sciences Initiative for Innovative Medicine (2016-I2M-3-021).

Conflicts of Interest and Sources of Funding: The authors declare that they have no competing interests.

Correspondence: Xiang-Sheng Chen, MD, National Center for STD Control, 12 Jiangwangmiao St, Nanjing 210042, China. E-mail:

Received for publication October 30, 2017, and accepted February 13, 2018.

© Copyright 2018 American Sexually Transmitted Diseases Association