Reading a few papers from 2020 onwards, it seems that even in the 1940s, after the introduction of penicillin in the treatment of gonorrhea, resistance became an issue with the global spread of N. gonorrhoeae, which resulted in high-level resistance that could not be overcome by increased penicillin dose.
That said, according to may papers, as for now, elevated ceftriaxone doses of 1–2 g still seem to be sufficient for gonorrhea treatment, since even in China it has remained without treatment failure. Also, some of the high-level ceftriaxone-resistant strains, such as the FC428 clone, appear to be more susceptible to ertapenem.
The literature suggests that a future scenario might play out in which gonorrhea will require individualized treatments based on actual antimicrobial susceptibility levels determined for each case.
That said, according to may papers, as for now, elevated ceftriaxone doses of 1–2 g still seem to be sufficient for gonorrhea treatment, since even in China it has remained without treatment failure. Also, some of the high-level ceftriaxone-resistant strains, such as the FC428 clone, appear to be more susceptible to ertapenem.
The literature suggests that a future scenario might play out in which gonorrhea will require individualized treatments based on actual antimicrobial susceptibility levels determined for each case.