Efficacy and Safety of Injectable and Oral Antibiotics in Treating Gonorrhea: A Systematic Review and Network Meta-Analysis

Abstract

Gonorrhea is the second most frequently reported sexually transmitted infectious disease of bacterial origin in the world. Current empiric therapies rely on broad-spectrum antibiotics. However, treatment options are becoming limited due to the rise of drug-resistant gonorrhea. To control the rise of drug-resistant gonorrhea and to identify alternative treatment options, clinicians will have to increasingly rely on experimental evidence for the treatment of gonorrhea patients. Thus, we performed a systematic review and network meta-analysis of all randomized clinical trials about the efficacy and safety of various antibiotic regimens in adults with gonorrhea. We searched all references in Embase and PubMed from the date of their inception to January 2019, and then an updated search was performed in March 2019. Of the 28,843 identified references, 44 fulfilled our selection criteria. We used a network meta-analysis based on a frequentist approach to evaluate the efficacy and safety of 12 injectable and 11 oral antibiotics. The efficacy of treatments was ranked by p score and inconsistency was assessed by a back-calculation method. Certainty of evidence was evaluated by the GRADE system. For injectable drugs, there was no difference in efficacy between a reference antibiotic and other drugs. However, ceftriaxone had significantly better efficacy than cefuroxime (OR, 12.03; cephaloridine (OR, 42.41; kanamycin (OR, 5.45; penicillin (OR, 13.11;, and spectinomycin (OR, 4.70; 95% CI 1.62-13.62). Thus, ceftriaxone was the most effective injectable drug (p score of 0.924). As for oral drugs, azithromycin was the most effective compound (p score of 0.8633). There were no significant differences in safety between injectable and oral treatments. In our systematic review of randomized controlled trials, we found azithromycin and ceftriaxone to be the most effective antibiotics for the treatment of gonorrhea. This is in line with current guidelines which recommend a combination therapy of azithromycin and ceftriaxone for the treatment of gonorrhea due to increased antimicrobial resistance. Our analysis identified gentamicin and ofloxacin as alternative therapeutics to treat drug-resistant gonorrhea.

A Comparison of Spectinomycin with Ceftriaxone as Treatment for Uncomplicated Gonorrhea

“…Number of gonorrhoea cases decreased from 106 million in 2008 to 78 million in 2016, per WHO statistics. 14,21 Most of the gonorrhoea victims in this study are 20-40 years old, and the proportion of male patients substantially higher than females with urethral discharge and dysuria is comparable with published studies in other countries. 15,22 Early diagnosis and treatment for gonorrhoea allows for a complete recovery.…”

Efficacy and Safety of Antibiotics for Treatment of Scrub Typhus

“…The P score is used to measure the extent of certainty that a treatment is better than other JAMA Network Open | Infectious Diseases treatments, averaged over all competing treatments. 33,34 The P score is measured on a scale from 0 (worst) to 1 (best). Hence, if one treatment is better than the other treatments, its P score will be larger.…”

“…To rank the efficacy, safety, and defervescence time of antibiotics, we used the P score as an indicator. The P score is used to measure the extent of certainty that a treatment is better than other treatments, averaged over all competing treatments . The P score is measured on a scale from 0 (worst) to 1 (best).…”

Unintended consequences: the potential impacts of the British Association for Sexual Health and HIV (BASHH) 2019 gonorrhoea guidelines

“…4 The 2019 UK guidelines currently differ in first line treatment choice from other previously published national or international guidance including that of the United States of America (USA), 5 Europe, 6 and the World Health Organization (WHO) 7 who continue to recommend combination therapy (although sometimes with lower dose ceftriaxone) which is supported by a recent meta-analysis. 8 Guidelines from the USA and Europe recommend presumptive treatment of all partners within 60 days of diagnosis or symptoms of gonorrhoea in the index case, with those from the USA allowing the use of expedited partner therapy where required to ensure treatment. 5,6 The WHO guidelines do not address partner notification.…”