Antimicrobial resistance of several sexually transmitted pathogens has been increasing in many parts of the world and this has rendered some low-cost regimens ineffective. Recommendations to use more effective drugs frequently raise concerns about cost and possible misuse.
A two-tier drug policy with the provision of less effective drugs at the peripheral health care level and the most effective and usually more expensive drugs only at a referral level may result in an unacceptable rate of treatment failures, complications and referrals, and may erode confidence in health services. This approach is not recommended. The drugs used for STI in all health care facilities should be at least 95% effective. Criteria for the selection of drugs are listed in the box below.
Criteria for the selection of STI drugs
Drugs selected for treating STI should meet the following criteria:
• high efficacy (at least 95%)
• low cost
• acceptable toxicity and tolerance
• organism resistance unlikely to develop or likely to be delayed
• single dose
• oral administration
• not contraindicated for pregnant or lactating women.
Appropriate drugs should be included in the national Essential Drugs list and in choosing drugs, consideration should be given to the capabilities and experience of health personnel.