Effectiveness of gentamicin for gonorrhoea treatment: systematic review and meta-analysis

Dowell, Deborah; Kirkcaldy, Robert D.

doi:10.1136/sextrans-2012-050604

Cited by 38 publications

(26 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, correlates between MICs of gentamicin, pharmacokinetic/pharmacodynamic parameters, and treatment outcomes and, consequently, evidence-based microbiological resistance breakpoints are lacking. Finally, single-dose gentamicin treatment had a pooled cure rate of only 91.5% in a recent meta-analysis (304). The novel oral fluoroketolide solithromycin was recently shown to have high in vitro activity against gonococci, including ESCresistant XDR and MDR isolates (305).…”

Section: Future Perspectives For Treatmentmentioning

confidence: 99%

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

2014

View full text Add to dashboard Cite

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.

show abstract

Section: Future Perspectives For Treatmentmentioning

confidence: 99%

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

2014

View full text Add to dashboard Cite

show abstract

“…This combination is currently under clinical study and may be valuable if infection persists after treatment with ceftriaxone. 73,74 Gentamicin has been successfully used in Malawi, Africa for many years (mainly in syndromic management administered together with doxycycline) 75 and high in-vitro susceptibility in Europe has been proven. 76 However, randomized, quality assured clinical trials need to confirm the efficacy of this treatment regimen.…”

Section: Therapy Of Genital Anorectal and Pharyngeal Gonococcal Infementioning

confidence: 99%

2012 European guideline on the diagnosis and treatment of gonorrhoea in adults

2013

View full text Add to dashboard Cite

Gonorrhoea is a major public health concern globally. Of particularly grave concern is that resistance to the extended-spectrum cephalosporins has emerged during the most recent years. This guideline provides recommendations regarding the diagnosis and treatment of gonorrhoea in Europe. Compared to the outdated 2009 European gonorrhoea guideline, this 2012 European gonorrhoea guideline provides up-to-date guidance on, broader indications for testing and treatment of gonorrhoea; the introduction of dual antimicrobial therapy (ceftriaxone 500 mg and azithromycin 2 g) for uncomplicated gonorrhoea when the antimicrobial sensitivity is unknown; recommendation of test of cure in all gonorrhoea cases to ensure eradication of infection and identify emerging resistance; and recommendations to identify, verify and report failures with recommended treatment regimens. Optimisations of the testing, diagnostics, antimicrobial treatment and follow-up of gonorrhoea patients are crucial in controlling the emergent spread of cephalosporin-resistant and multidrug-resistant gonorrhoea.

show abstract

“…From a global public health perspective, an effective antimicrobial monotherapy remains crucial. Gentamicin (16)(17)(18), solithromycin (19), and ertapenem (20) have been suggested; however, none of these appear to be an effective long-term solution for single antimicrobial therapy of gonorrhea.…”

mentioning

confidence: 99%

Neisseria gonorrhoeae Strain with High-Level Resistance to Spectinomycin Due to a Novel Resistance Mechanism (Mutated Ribosomal Protein S5) Verified in Norway

Unemo

Golparian

Skogen

et al. 2013

Antimicrob Agents Chemother

View full text Add to dashboard Cite

Gonorrhea may become untreatable, and new treatment options are essential. Verified resistance to spectinomycin is exceedingly rare. However, we describe a high-level spectinomycin-resistant (MIC, >1,024 g/ml) Neisseria gonorrhoeae strain from Norway with a novel resistance mechanism. The resistance determinant was a deletion of codon 27 (valine) and a K28E alteration in the ribosomal protein 5S. The traditional spectinomycin resistance gene (16S rRNA) was wild type. Despite this exceedingly rare finding, spectinomycin available for treatment of ceftriaxone-resistant urogenital gonorrhea would be very valuable.

show abstract

Effectiveness of gentamicin for gonorrhoea treatment: systematic review and meta-analysis

Abstract: Gentamicin does not meet current CDC criteria for recommended treatment of gonorrhoea. However, if cephalosporin resistance emerges, gentamicin may be a useful alternative agent. Evaluation of additional regimens, including combination therapy, is warranted.

Cited by 38 publications

References 23 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

2012 European guideline on the diagnosis and treatment of gonorrhoea in adults

Neisseria gonorrhoeae Strain with High-Level Resistance to Spectinomycin Due to a Novel Resistance Mechanism (Mutated Ribosomal Protein S5) Verified in Norway

Contact Info

Product

Resources

About