Pharyngeal gonorrhoea – is dual therapy the way forward?

Sathia, Leena; Ellis, Benjamin; s, Phillip; Winston, Alan; Smith, Alan

doi:10.1258/095646207781568556

Cited by 40 publications

(26 citation statements)

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“…Azithromycin is not currently a recommended treatment for gonorrhoea12 but it is proposed that it might be effective as part of a dual treatment in the treatment of pharyngeal gonorrhoea 25 26. It is therefore important to monitor azithromycin resistance, particularly as the gonococcal population is frequently exposed to this drug as the recommended treatment for Chlamydia trachomatis co-infection.…”

Section: Discussionmentioning

confidence: 99%

European surveillance of antimicrobial resistance in Neisseria gonorrhoeae

Cole¹,

Chisholm²,

Hoffmann

et al. 2010

Sexually Transmitted Infections

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Results: Rates of resistance to ciprofloxacin, the previously recommended treatment, were high across Europe (42% -52%) indicating usage is no longer appropriate. While resistance to the currently recommended treatment, ceftriaxone, was not demonstrated, a concerning upward drift in the MIC distribution was identified since an earlier European study in 2004. No resistance to spectinomycin was observed whereas azithromycin resistance varied from 2% to 7% and isolates from Scotland (n=4) and Ireland (n=1) showed high level resistance (MIC >256 mg/l). High-level resistance to tetracycline and penicillin remained relatively constant at 16% and 12% respectively.

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Section: Discussionmentioning

confidence: 99%

European surveillance of antimicrobial resistance in Neisseria gonorrhoeae

Cole¹,

Chisholm²,

Hoffmann

et al. 2010

Sexually Transmitted Infections

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“…In an effort to improve treatment efficacy and to delay the further selection of cephalosporin-resistant N. gonorrhoeae, most treatment guidelines now recommend the use of adjunctive azithromycin (AZM) or doxycycline to be administered in conjunction with cephalosporin therapy (4)(5)(6). While not recommended as monotherapy except in the case of severe cephalosporin allergy, AZM is often preferred to adjuvant therapy because it offers the convenience of single-dose therapy and demonstrates a lower prevalence of resistance than doxycycline, and preliminary data suggest that AZM may be more effective as synergistic therapy with 3GC, particularly in the treatment of pharyngeal gonorrhea (7)(8)(9).…”

mentioning

confidence: 99%

Azithromycin Resistance Is Coevolving with Reduced Susceptibility to Cephalosporins in Neisseria gonorrhoeae in Ontario, Canada

Allen

Seah

Martín

et al. 2014

Antimicrob Agents Chemother

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d Azithromycin (AZM) is routinely recommended as a component of dual therapy for gonorrhea in combination with third-generation cephalosporins (3GC). In this study, we examined the prevalence of AZM-resistant (AZM r ) Neisseria gonorrhoeae from July 2010 to February 2013, assessed the rate of concurrent cephalosporin resistance under the current treatment recommendations, and analyzed the clonal distribution of AZM r isolates in Ontario, Canada. Nineteen AZM r clinical isolates (one per patient; MIC, >2 g/ml) were included in the study. Susceptibility profiles of these isolates to 11 antibiotics, molecular typing, characterization of macrolide resistance mechanisms, and penicillin-binding protein 2 (PBP2) patterns were determined for all the isolates. Two groups were defined based on AZM r level; group A isolates displayed high-level resistance (MIC, >2,048 g/ml) due to mutations (A2143G) in the four copies of the 23S rRNA rrl gene, and group B isolates had moderate resistance to AZM (MICs, 2 to 8 g/ml, C2599T mutation in the rrl gene), with a subgroup belonging to sequence type 3158 (ST3158) (n ‫؍‬ 8), which also showed reduced susceptibility to 3GC (MICs, 0.12 to 0.25 g/ml, PBP2 pattern XXXIV). This AZM r phenotype was not observed in previous provincial surveillance in 2008 (the ST3158 clone was found, with AZM MICs of 0.25 to 0.5 g/ml associated with mtrR mutations). We hypothesized that the AZM mutant prevention concentration (MPC) in the ST3158 subpopulation we found in 2008 was higher than the MPC in wild-type isolates (AZM MIC, <0.031 g/ml), increasing the chances of additional selection of AZM r mutations. Full AZM resistance is now emerging in this clone together with reduced susceptibility to 3GC, threatening the future efficacy of these antibiotics as therapeutic options for treatment of gonorrhea.

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“…However, patients with gonorrhea already frequently receive dual therapy for gonorrhea, because they are routinely co-treated for chlamydia. There is some evidence that coadministration of a cephalosporin and azithromycin may treat pharyngeal gonorrhea infection more effectively than use of a cephalosporin alone [66,67]. For this reason, and because routine co-treatment might limit development of antimicrobial-resistant N. gonorrhoeae, the CDC's 2010 STD treatment guidelines recommend routine use of azithromycin or doxycycline with a cephalosporin to treat gonorrhea, whether or not chlamydia is ruled out [10•].…”

Section: How Could We Treat Cephalosporin-resistant Gonorrhea?mentioning

confidence: 99%

Gonococcal Resistance: Are Cephalosporins Next?

Kirkcaldy

Ballard

Dowell

2011

Curr Infect Dis Rep

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The development of resistance to multiple antibiotics has limited treatment options for gonorrhea in many countries. Currently, the Centers for Disease Control and Prevention only recommend cephalosporin antibiotics for treatment of uncomplicated gonorrhea. Although the cephalosporins remain effective, the demonstrated ability of Neisseria gonorrhoeae to develop resistance has raised concerns about the possibility of multidrug-resistant N. gonorrhoeae strains, which include cephalosporin resistance. This article provides a review of global trends in cephalosporin susceptibility among gonococcal isolates, recent findings that deepen our understanding of genetic mechanisms of resistance, and the public health and clinical implications of the potential emergence of cephalosporin-resistant gonorrhea.

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Pharyngeal gonorrhoea – is dual therapy the way forward?

Cited by 40 publications

References 1 publication

European surveillance of antimicrobial resistance in Neisseria gonorrhoeae

European surveillance of antimicrobial resistance in Neisseria gonorrhoeae

Azithromycin Resistance Is Coevolving with Reduced Susceptibility to Cephalosporins in Neisseria gonorrhoeae in Ontario, Canada

Gonococcal Resistance: Are Cephalosporins Next?

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