Evaluating spatially adaptive guidelines for the treatment of gonorrhea to reduce the incidence of gonococcal infection and increase the effective lifespan of antibiotics

Abstract

In the absence of point-of-care gonorrhea diagnostics that report antibiotic susceptibility, gonorrhea treatment is empiric and determined by standardized guidelines. These guidelines are informed by estimates of resistance prevalence from national surveillance systems. We examined whether guidelines informed by local, rather than national, surveillance data could reduce the incidence of gonorrhea and increase the effective lifespan of antibiotics used in treatment guidelines. We used a transmission dynamic model of gonorrhea among men who have sex with men (MSM) in 16 U.S. metropolitan areas to determine whether spatially adaptive treatment guidelines based on local estimates of resistance prevalence can extend the effective lifespan of hypothetical antibiotics. The rate of gonorrhea cases in these metropolitan areas was 5,548 cases per 100,000 MSM in 2017. Under the current strategy of updating the treatment guideline when the prevalence of resistance exceeds 5%, we showed that spatially adaptive guidelines could reduce the annual rate of gonorrhea cases by 200 cases (95% uncertainty interval: 169, 232) per 100,000 MSM population while extending the use of a first-line antibiotic by 0.75 (0.55, 0.95) years. One potential strategy to reduce the incidence of gonorrhea while extending the effective lifespan of antibiotics is to inform treatment guidelines based on local, rather than national, resistance prevalence.

Analysis of the dynamics of <i>Neisseria gonorrhоeaе</i> resistance to antimicrobial drugs in the Russian Federation for the period 2005–2021

“…Более того, в 2021 г. было выявлено только 3% резистентных штаммов N. gonorrhoeae, что укладывается в допустимые границы согласно требованиям ВОЗ к эффективности терапии антибактериальными препаратами (не более 5%) (WHO, 2012). Однако данный порог в настоящее время обсуждается -как в сторону увеличения верхнего предела резистентных штаммов [12], так и снижения порога до 1-3%, как правило, «из ключевых групп населения с потенциалом более частой передачи инфекции или многим половым партнерам, таким как работники секс-бизнеса и мужчины, имеющие половые контакты с мужчинами» [13]. Таким образом, несмотря на то, что назначение спектиномицина как альтернативного препарата лечения происходит исключительно под контролем чувствительности конкретного клинического изолята, на текущий момент он остается наиболее перспективным альтернативным препаратом для лечения гонококковой инфекции.…”

Evaluating Efficiency of the US Surveillance Systems for Monitoring Antimicrobial-Resistant Gonorrhea: An Agent-Based Modelling Study

“…For data that we have for incidence of gonorrhea no confidence interval was reported. We assumed that it was calculated with 20% error and used the approach described in [22] to calculate the values of M and m.…”

Recent approaches in computational modelling for controlling pathogen threats

“…Others have also argued that combination therapy is the best approach to reduce AMR, including an elegant in vitro experimental model using well plates to simulate individuals in a hospital population ( Angst et al, 2021 ). AMR may be driven more by the wide distribution of use than its intensity ( Olesen et al, 2018 ), and some have argued that for Neisseria gonorroeae issuing prescribing guidelines based on local prevalence thresholds could reduce cases and prolong the lifespan of antibiotics ( Yaesoubi et al, 2022 ).…”