Cephalosporin resistant<i>Neisseria gonorrhoeae</i>: time to consider gentamicin?

Ross, Jonathan; Lewis, David A.

doi:10.1136/sextrans-2011-050362

Cited by 42 publications

(27 citation statements)

References 20 publications

(12 reference statements)

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“…The parenteral aminoglycoside gentamicin has been used as a first-line treatment for 20 years in Malawi, without any obvious in vitro resistance (301,302), and in Europe the in vitro susceptibility is also high (303). Nevertheless, in Malawi, gentamicin has mainly not been used for gentamicin monotherapy but instead for syndromic management of urogenital infections, together with doxycycline, and no data regarding treatment efficacy against pharyngeal or anorectal gonorrhea exist.…”

Section: Future Perspectives For Treatmentmentioning

confidence: 99%

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

2014

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SUMMARY Neisseria gonorrhoeae is evolving into a superbug with resistance to previously and currently recommended antimicrobials for treatment of gonorrhea, which is a major public health concern globally. Given the global nature of gonorrhea, the high rate of usage of antimicrobials, suboptimal control and monitoring of antimicrobial resistance (AMR) and treatment failures, slow update of treatment guidelines in most geographical settings, and the extraordinary capacity of the gonococci to develop and retain AMR, it is likely that the global problem of gonococcal AMR will worsen in the foreseeable future and that the severe complications of gonorrhea will emerge as a silent epidemic. By understanding the evolution, emergence, and spread of AMR in N. gonorrhoeae , including its molecular and phenotypic mechanisms, resistance to antimicrobials used clinically can be anticipated, future methods for genetic testing for AMR might permit region-specific and tailor-made antimicrobial therapy, and the design of novel antimicrobials to circumvent the resistance problems can be undertaken more rationally. This review focuses on the history and evolution of gonorrhea treatment regimens and emerging resistance to them, on genetic and phenotypic determinants of gonococcal resistance to previously and currently recommended antimicrobials, including biological costs or benefits; and on crucial actions and future advances necessary to detect and treat resistant gonococcal strains and, ultimately, retain gonorrhea as a treatable infection.

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Section: Future Perspectives For Treatmentmentioning

confidence: 99%

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

2014

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“…The absence of resistance to gentamicin is encouraging, but an isolate showed MIC of 6 µg/mL, which needed monitoring. Studies with gentamicin were conducted in some countries (18)(19)(20) and their good perspectives encourage its use for gonorrhea treatment (21) . Comparing our results with the other countries in South America (22) , we notice that decrease of resistance to penicillin and tetracycline has also been detected.…”

Section: Notementioning

confidence: 99%

Susceptibility of neisseria gonorrhoeae to gentamicin, chloramphenicol and other antibiotics in Manaus, Amazon, Brazil

Ferreira¹,

Vasconcelos²,

Gomes³

et al. 2015

J Bras Doenças Sex Transm

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We notify the antimicrobial tests of 83 N. gonorrhoeae isolates. The results showed that it is not viable to use penicillin and tetracycline to treat the disease. The resistance to quinolones has not precluded therapy yet. All gonococci were sensitive to ceftriaxone, and the low level of resistance to gentamicin and chloramphenicol may suggest their usage as a future therapeutic option. Keywords: Neisseria gonorrhoeae; antimicrobial; gentamicins; chloramphenicol; resistance. RESUMOReportamos os resultados de testes de suscetibilidade realizados com 83 isolados de N. gonorrhoeae. Os resultados demonstram que não é viável a utilização de penicilina e tetraciclina para o tratamento da doença. A frequência de resistência às quinolonas detectada neste corte ainda possibilita sua utilização na terapêutica. Todos os gonococos testados foram sensíveis à ceftriaxona. O reduzido nível de resistência à gentamicina e ao cloranfenicol demonstra que esses antibióticos podem ser utilizados como opção terapêutica futura.

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“…Gentamicin has been used for the past 2 decades in the management of gonorrhea in Malawi (8,9). Gentamicin has been considered an option for the treatment of infections due to the MDR and XDR strains and for future treatment of gonorrhea particularly in dual therapy in other geographic regions (10)(11)(12).…”

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confidence: 99%

Gentamicin Susceptibility among a Sample of Multidrug-Resistant Neisseria gonorrhoeae Isolates in India

Bala

Singh

Bhargava

et al. 2016

Antimicrob Agents Chemother

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bAntimicrobial susceptibility testing of 258 Neisseria gonorrhoeae isolates by Etest determined that 60.1% were multidrug resistant (MDR), while 5% of the strains had decreased susceptibility to currently recommended extended-spectrum cephalosporins (ESCs). Among these, 84.5% of MDR strains and 76.9% of strains that had decreased susceptibility to ESCs were susceptible to gentamicin. No MDR isolate was resistant to gentamicin. These in vitro results suggest that gentamicin might be an effective treatment option for the MDR strains and in dual therapy for gonorrhea. However, further research regarding the clinical treatment outcomes is essential. N eisseria gonorrhoeae clinical isolates resistant to extendedspectrum cephalosporins (ESCs), the last remaining options for empirical therapy, and most other antimicrobials have been reported worldwide in recent years (1-4). Organizations such as the World Health Organization (WHO), the U.S. Centers for Disease Control and Prevention (CDC), and the European Centre for Disease Prevention and Control (ECDC) are considering infections caused by multidrug-resistant (MDR) and extensively drugresistant (XDR) N. gonorrhoeae major public health problems (5-7). With the increasing prevalence of drug resistance, there is an urgent need for new and effective treatment options. Gentamicin has been used for the past 2 decades in the management of gonorrhea in Malawi (8, 9). Gentamicin has been considered an option for the treatment of infections due to the MDR and XDR strains and for future treatment of gonorrhea particularly in dual therapy in other geographic regions (10-12).Earlier studies focused on the in vitro susceptibility of N. gonorrhoeae to gentamicin (8,(13)(14)(15)(16)(17). Some of these studies were on a limited number of isolates (13,17). To the best of our knowledge, no study has analyzed the in vitro susceptibility of gentamicin against MDR strains. Therefore, this study was aimed at determining the (i) trend of in vitro susceptibility of N. gonorrhoeae isolates to gentamicin during 2010 to 2015, (ii) status of gentamicin susceptibility for MDR strains and strains with decreased susceptibility to ESCs, and (iii) profile of gentamicin-less-susceptible (LS) strains for eight other antimicrobials recommended currently and in the past for treatment of gonorrhea.A total of 258 N. gonorrhoeae isolates obtained from consecutive patients attending a sexually transmitted disease (STD) clinic from August 2010 to December 2015 were identified on the basis of colony morphology, Gram staining, and oxidase, superoxol, and carbohydrate utilization tests (18). Susceptibility testing for gentamicin and other antimicrobials, such as ESCs (ceftriaxone, cefpodoxime, cefixime), penicillin, tetracycline, ciprofloxacin, spectinomycin, and azithromycin, was performed using the Etest strip per manufacturer instructions (bioMérieux SA, France) on GC agar (Becton, Dickinson and Company [BD], Sparks, MD) containing 1% vitamin growth supplement (HiMedia, India) or Isovitalex (BD). Susceptibilit...

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Cephalosporin resistantNeisseria gonorrhoeae: time to consider gentamicin?

Cited by 42 publications

References 20 publications

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

Susceptibility of neisseria gonorrhoeae to gentamicin, chloramphenicol and other antibiotics in Manaus, Amazon, Brazil

Gentamicin Susceptibility among a Sample of Multidrug-Resistant Neisseria gonorrhoeae Isolates in India

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