Materiały źródłowe

• #1 Gonococcal Infections Among Adolescents and Adults – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/gonorrhea-adults.htm

  Gonorrhea treatment is complicated by the ability of N. gonorrhoeae to develop resistance to antimicrobials. In 1986, the Gonococcal Isolate Surveillance Project (GISP), a national sentinel surveillance system, was established to monitor trends in antimicrobial susceptibilities of urethral N. gonorrhoeae strains in the United States. The epidemiology of antimicrobial resistance guides decisions about gonococcal treatment recommendations and has evolved because of shifts in antimicrobial resistance patterns. During 2007, emergence of fluoroquinolone-resistant N. gonorrhoeae in the United States prompted CDC to cease recommending fluoroquinolones for gonorrhea treatment, leaving cephalosporins as the only remaining class of antimicrobials available for gonorrhea treatment in the United States. Reflecting concern about emerging gonococcal resistance, CDCs 2010 STD treatment guidelines recommended dual therapy for gonorrhea with a cephalosporin plus either azithromycin or doxycycline, even if NAAT for C. trachomatis was negative at the time of treatment. However, during 2006-2011, the minimum concentrations of cefixime needed to inhibit in vitro growth of the N. gonorrhoeae strains circulating in the United States and other countries increased, demonstrating that cefixime effectiveness might be waning. Consequently, CDC no longer recommends cefixime as a first-line regimen for gonorrhea treatment in the United States. Since 2013, the proportion of GISP isolates that demonstrate reduced susceptibility to azithromycin has increased almost tenfold, to 5.1% in 2019. Only ceftriaxone is recommended for treating gonorrhea in the United States.

• #2 Management of Gonorrhea in Adolescents and Adults in the United States

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6750764/

  Gonorrhea is the second most commonly reported notifiable disease in the United States and is associated with serious health sequelae, including pelvic inflammatory disease, infertility, and ectopic pregnancy. Treatment for gonorrhea has been complicated by antimicrobial resistance. Neisseria gonorrhoeae has developed resistance to each of the antimicrobials that were previously recommended as first-line treatment regimens, and current treatment options are severely limited. […] Timely and effective treatment is an essential component of gonorrhea control programs. It reduces transmission in the community by shortening the duration of infection and decreases the risk of serious health sequelae, including pelvic inflammatory disease, infertility, and ectopic pregnancy. Unfortunately, treatment for gonorrhea has been complicated by antimicrobial resistance. Neisseria gonorrhoeae has progressively developed resistance to each of the antimicrobials that were previously recommended as first-line treatment regimens, and current treatment options are severely limited.

• #3 Gonorrhea Medication: Antibiotics, Other

  https://emedicine.medscape.com/article/218059-medication

  Rapid cure of gonorrhea is critical to curtail transmission. Because of emerging resistance that has resulted in limited choices for antibiotics, it is imperative to follow treatment guidelines to avoid further resistance and to obtain optimal treatment results. […] Medical therapy requires dual antibiotic treatment with efficacy against N gonorrhoeae. Until several years ago, the treatment of choice involved oral medication for as long as 10 days or an injection; however, patients tend to be poorly compliant with medications for various reasons, and the availability of newer medications has allowed in-office single-doses of ceftriaxone IM plus azithromycin PO treatment to ensure compliance. […] Disseminated or complicated infections (eg, endocarditis, meningitis) require more prolonged, inpatient therapy. For these cases, an infectious disease consultation is essential.

• #4 Gonococcal Infections Among Adolescents and Adults – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/gonorrhea-adults.htm

  Recommended Regimen for Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum Among Adults and Adolescents: Ceftriaxone 500 mg IM in a single dose for persons weighing 150 kg. If chlamydial infection has not been excluded, treat for chlamydia with doxycycline 100 mg orally 2 times/day for 7 days. […] Single-dose injectable cephalosporin regimens, other than ceftriaxone, that are safe and have been effective against uncomplicated urogenital and anorectal gonococcal infections in the past include ceftizoxime (500 mg IM), cefoxitin (2 g IM with probenecid 1 g orally), and cefotaxime (500 mg IM). None of these injectable cephalosporins offer any advantage over ceftriaxone 250 mg for urogenital infection, and efficacy for pharyngeal infection is less certain. […] If cephalosporin allergy: Gentamicin 240 mg IM in a single dose PLUS Azithromycin 2 g orally in a single dose.

• #5 Chlamydial and Gonococcal Infections: Screening, Diagnosis, and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0400/p388.html

  Infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae are increasing in the United States. Uncomplicated gonococcal infection should be treated with a single 500-mg dose of intramuscular ceftriaxone in people weighing less than 331 lb (150 kg). All nonpregnant people should be tested for reinfection approximately three months after treatment or at the first visit in the 12 months after treatment. Pregnant patients diagnosed with chlamydia or gonorrhea should have a test of cure four weeks after treatment. […] Doxycycline should be used to treat chlamydia in nonpregnant people. […] In 2018, more than one-half of cases of gonococcal infection were estimated to be resistant to at least one drug, leading the CDC to change treatment recommendations to higher doses of ceftriaxone. Azithromycin is no longer a recommended therapy for nonpregnant individuals because of an observed sevenfold increase in gonococcal resistance between 2013 and 2018.

• #6 Management of Gonorrhea in Adolescents and Adults in the United States

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6750764/

  The available clinical data indicate that ceftriaxone 250 mg is effective in approximately 99% of uncomplicated urethral, cervical, and rectal gonococcal infections. There are no clinical data to support the administration of ceftriaxone at higher doses than 250 mg. Therefore, dual treatment for gonorrhea that includes ceftriaxone at the 250-mg dose is recommended for the treatment of uncomplicated urethral, cervical, and rectal gonococcal infections. […] When azithromycin 1 g is given as part of a dual treatment regimen with ceftriaxone, development and subsequent transmission of azithromycin resistance is unlikely. Therefore, based on the effectiveness of azithromycin 1 g and the increased adverse effects associated with the 2 g dose, azithromycin 1 g should be used when given as part of a dual treatment regimen with ceftriaxone.

• #7 Gonorrhea: Symptoms, Treatment, Causes, and More

  https://www.healthline.com/health/gonorrhea

  Gonorrhea is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhea. Its usually cured with antibiotics. […] The recommended treatment for gonorrhea is a one-time intramuscular injection of the antibiotic ceftriaxone. Typically, youll get this shot in the buttocks. […] A healthcare professional may also prescribe an oral medication, such as a twice-daily dose of doxycycline for 7 days if chlamydia is suspected. […] The CDC previously recommended ceftriaxone plus azithromycin, but the guidelines were changed because the bacteria causing gonorrhea are becoming increasingly resistant to azithromycin. […] After taking these antibiotics, you should begin to feel relief from any symptoms within days but youll need to wait a full week after finishing your medications before participating in any sexual activity. […] If your symptoms persist for more than a few days after treatment, youll need to contact a clinic or healthcare center for retesting. […] For oral gonorrhea, youll need to follow up with a healthcare professional 1 to 2 weeks later to make sure the infection has cleared.

• #8 Gonococcal Infections Among Adolescents and Adults – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/gonorrhea-adults.htm

  If ceftriaxone administration is not available or not feasible: Cefixime 800 mg orally in a single dose. […] Monotherapy with azithromycin 2 g orally as a single dose has been demonstrated to be 99.2% effective against uncomplicated urogenital gonorrhea. However, monotherapy is not recommended because of concerns about the ease with which N. gonorrhoeae can develop resistance to macrolides, the high proportion of isolates with azithromycin decreased susceptibility, and documented azithromycin treatment failures. […] Patients with suspected treatment failures should first be retreated routinely with the initial regimen used (ceftriaxone 500 mg IM), with the addition of doxycycline if chlamydia infection exists, because reinfections are more likely than actual treatment failures. However, in situations with a higher likelihood of treatment failure than reinfection, relevant clinical specimens should be obtained for culture and antimicrobial susceptibility testing before retreatment.

• #9 Clinical Treatment of Gonorrhea | Gonorrhea | CDC

  https://www.cdc.gov/gonorrhea/hcp/clinical-care/index.html

  There is currently only one recommended treatment for uncomplicated gonorrhea. […] At present, the only CDC-recommended treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea is monotherapy with a single intramuscular dose of ceftriaxone 500 mg. If the recommended injectable treatment is not possible, then EPT via a single dose of 800mg cefixime should be considered. […] Under current guidelines every effort should be made to ensure that a patients sex partners are evaluated and treated with the recommended regimen (a single dose of ceftriaxone 500 mg IM). However, because that is not always possible, providers should still consider EPT for partners of patients diagnosed with gonorrhea who are unlikely to access timely evaluation and treatment. […] In cases where gonorrhea expedited partner therapy (provision of prescriptions or medications for the patient to take to his or her sex partner without the health care provider first examining the partner) is permissible by state law and the partner is unable or unlikely to seek timely treatment, the partner may be treated with a single 800 mg dose of cefixime, if a chlamydia infection in the patient has been excluded.

• #10 Gonorrhea Treatment & Management: Approach Considerations, Pharmacologic Treatment Regimens, Consultations

  https://emedicine.medscape.com/article/218059-treatment

  Treatment for uncomplicated urogenital, anorectal, and pharyngeal gonococcal infection is ceftriaxone 500 mg intramuscular (IM) given in a single dose. […] Treatment for coinfection with Chlamydia trachomatis with oral doxycycline (100 mg twice daily for 7 days) should be administered when chlamydial infection has not been excluded. Ceftriaxone is safe and effective in pregnant women and probably destroys incubating syphilis. Its major drawback is the necessity for IM administration. […] In patients who are cephalosporin allergic, a single 240 mg IM dose of gentamicin plus a single 2 g oral dose of azithromycin is an option. […] A single 800 mg oral dose of cefixime is an alternative regimen. However, cefixime does not provide as high, or as sustained, bactericidal blood levels as does ceftriaxone and demonstrates limited treatment efficacy for pharyngeal gonorrhea.

• #11 Gonorrhea – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/sexually-transmitted-infections-stis/gonorrhea

  For uncomplicated infection, a single dose of ceftriaxone. […] Uncomplicated gonococcal infection of the urethra, cervix, rectum, and pharynx is treated with the following: A single dose of ceftriaxone 500 mg IM (1 g IM for patients weighing 150 kg). […] If ceftriaxone is not available, use cefixime 800 mg orally in a single dose. […] If chlamydial infection has not been excluded, treat for chlamydia with doxycycline 100 mg orally twice a day for 7 days. […] Patients who are allergic to cephalosporins (including ceftriaxone) are treated with Gentamicin 240 mg IM in a single dose plus azithromycin 2 g orally in a single dose. […] DGI with gonococcal arthritis is initially treated with IM or IV antibiotics (eg, ceftriaxone 1 g IM or IV every 24 hours, ceftizoxime 1 g IV every 8 hours, cefotaxime 1 g IV every 8 hours) continued for 24 to 48 hours once symptoms lessen, followed by oral therapy guided by antimicrobial susceptibility testing, for a total treatment course of at least 7 days.

• #12 Gonorrhea guide: Treatment and follow-up – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/gonorrhea/treatment-follow-up.html

  Alternative NG treatment regimens are not recommended in pregnancy. In cases of cephalosporin allergy or other contraindications, consult with an infectious disease specialist. […] Treatment failure is defined as absence of reported sexual contact during the post-treatment period AND one of the following: Presence of Gram-negative intracellular diplococci on microscopy in specimens taken at least 72 hours after completion of treatment. […] Notify public health authorities of treatment failures.

• #13 Gonococcal Infections Among Adolescents and Adults – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/gonorrhea-adults.htm

  Recommended Regimen for Gonococcal Conjunctivitis Among Adolescents and Adults: Ceftriaxone 1 gm IM in a single dose. […] Infrequently, N. gonorrhoeae can cause disseminated infection. Hospitalization and consultation with an infectious disease specialist are recommended for initial therapy, especially for persons who might not comply with treatment, have an uncertain diagnosis, or have purulent synovial effusions or other complications. […] Recommended Regimen for Gonococcal-Related Arthritis and Arthritis-Dermatitis Syndrome: Ceftriaxone 1 g IM or by IV every 24 hours. If chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally 2 times/day for 7 days. […] Recommended Regimen for Gonococcal Meningitis and Endocarditis: Ceftriaxone 12 g IV every 12-24 hours. If chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally 2 times/day for 7 days.

• #14 Gonorrhea Treatment & Management: Approach Considerations, Pharmacologic Treatment Regimens, Consultations

  https://emedicine.medscape.com/article/218059-treatment

  Current recommendations in the treatment of gonococcal meningitis and endocarditis are to use ceftriaxone 1-2 g IV every 12-24 hours plus azithromycin 1 g PO for 1 dose. […] Per the 2015 CDC Sexually Transmitted Diseases Treatment Guidelines, a test-of-cure no longer is needed for patients with uncomplicated urogenital or rectal gonorrhea who are treated with recommended or alternative regimens. […] However, patients with pharyngeal gonorrhea treated with an alternative regimen should be tested 14 days after treatment and be tested for cure with NAAT assay or culture. […] Instruct patients with uncomplicated gonococcal infections to follow up with a primary care physician or public health provider to reduce the risk of future infection. […] In an effort to minimize transmission of gonorrhea, patients should refrain from all sexual activity for at least 7 days after treatment, and all sexual partners should undergo appropriate treatment.

• #15 Gonorrhea Treatment & Management: Approach Considerations, Pharmacologic Treatment Regimens, Consultations

  https://emedicine.medscape.com/article/218059-treatment

  In females, the decision is much more difficult, because the risk for complications is much higher. In light of high rates of noncompliance, reinfection, and poor follow-up, some clinicians advocate admitting a female patient whenever a question of a complication such as pelvic inflammatory disease (PID) is present, particularly in the adolescent population. […] Many institutions have attempted to quantify abnormalities found on pelvic examination (ie, the PID score) in an attempt to admit those patients with a higher likelihood of complications. […] In cases in which future fertility is at risk, most physicians are fairly aggressive, especially in situations in which the patient is very young or unfamiliar to them. […] Many physicians admit patients who have corneal involvement for treatment with IV antibiotics. These patients can be discharged once the infection is under control and the corneal infection is improving.

• #16 Gonorrhea Treatment & Management: Approach Considerations, Pharmacologic Treatment Regimens, Consultations

  https://emedicine.medscape.com/article/218059-treatment

  The prevention of gonococcal infections is based on education, mechanical or chemical prophylaxis, and early diagnosis and treatment. […] All infants born to mothers with untreated gonococcal infection should be treated prophylactically with a single dose of ceftriaxone (25-50 mg/kg IV/IM, not to exceed 125 mg). All neonates should undergo prophylaxis for ophthalmia neonatorum with silver nitrate (1%) aqueous solution in both eyes once or erythromycin (0.5%) ophthalmic ointment in both eyes once.

• #17 Gonorrhea – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gonorrhea/diagnosis-treatment/drc-20351780

  Adults with gonorrhea are treated with antibiotics. Due to emerging strains of drug-resistant Neisseria gonorrhoeae, the bacterium that causes gonorrhea, the Centers for Disease Control and Prevention recommends that uncomplicated gonorrhea be treated with the antibiotic ceftriaxone. This antibiotic is given as a shot, also called an injection. […] After getting the antibiotic, you can still spread the infection to others for up to seven days. So avoid sexual activity for at least seven days. […] Three months after treatment, the CDC also recommends getting tested for gonorrhea again. This is to make sure people haven’t been reinfected with the bacteria, which can happen if sex partners aren’t treated, or new sex partners have the bacteria. […] Your sexual partner or partners from the last 60 days also need to be screened and treated, even if they have no symptoms. If you are treated for gonorrhea and your sexual partners aren’t treated, you can become infected again through sexual contact. Make sure to wait until seven days after a partner is treated before having any sexual contact. […] Babies who develop gonorrhea after being born to someone with the infection can be treated with antibiotics.

• #18 Gonorrhea Medication: Antibiotics, Other

  https://emedicine.medscape.com/article/218059-medication

  Doxycycline inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. Doxycycline 100 mg PO BID for 10-14 days may be used in addition to a single dose of ceftriaxone 250 mg IM for gonococcal epididymitis or pelvic inflammatory disease. […] Erythromycin is the only antibiotic ophthalmic ointment recommended for use in neonates for prophylaxis of gonococcal ophthalmia neonatorum.

• #19 Gonorrhea: Treatment and Management Considerations for the Male Patient

  https://www.uspharmacist.com/article/gonorrhea-treatment-and-management-considerations-for-the-male-patient

  The CDC currently recommends that patients with uncomplicated gonococcal infections of the pharynx be treated with a regimen consisting of a single dose of ceftriaxone 250 mg IM in addition to a single oral dose of azithromycin 1 g. […] Patients with uncomplicated gonococcal infections of the cervix, urethra, and/or rectum do not require a follow-up test of cure if they are treated with a recommended first-line or alternative regimen. […] Patients who develop gonorrheal meningitis receive ceftriaxone 1 to 2 g IV every 12 to 24 hours for 10 to 14 days, plus a single oral dose of azithromycin 1 g. […] Appropriate treatment is of paramount importance for existing gonococcal infections, but preventive measures must also be considered and discussed with the patient. […] The partner of a patient with a gonococcal infection should be referred for evaluation and probable treatment if he or she had sexual contact with the patient within 60 days prior to diagnosis or onset of symptoms, or if he or she was the patient’s last sexual partner. […] Ceftriaxone and azithromycin are the recommended first-line regimen for most N gonorrhoeae infections.

• #20 Gonorrhea – Health Care Providers | Colorado Department of Public Health and Environment

  https://cdphe.colorado.gov/sti-hiv-vh/antibiotic-resistant-gonorrhea/health-care

  Gonorrhea can be cured with the right treatment. CDC recommends a single dose of 500 mg of intramuscular ceftriaxone*. Alternative regimens are available when ceftriaxone cannot be used to treat urogenital or rectal gonorrhea. […] Partners may be treated with a single dose of 800mg of oral cefixime. Seven days of 100mg doxycycline twice a day may be added if chlamydia is suspected. […] Be alert for individuals who have persistent symptoms despite CDC-recommended treatment. […] Any person with pharyngeal gonorrhea should return 714 days after initial treatment for a test of cure by using either culture or NAAT; however, testing at 7 days might result in an increased likelihood of false-positive tests. […] If the NAAT is positive, efforts should be made to perform a confirmatory culture before retreatment, especially if a culture was not already collected. […] Men or women who have been treated for gonorrhea should be retested 3 months after treatment regardless of whether they believe their sex partners were treated; scheduling the follow-up visit at the time of treatment is encouraged.

• #21 Gonorrhea – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/sexually-transmitted-infections-stis/gonorrhea

  Gonococcal purulent arthritis usually requires repeated synovial fluid drainage either with repeated arthrocentesis or arthroscopically. […] Posttreatment cultures are unnecessary if symptomatic response is adequate. However, for patients with symptoms for 7 days, specimens should be obtained, cultured, and tested for antimicrobial sensitivity. […] All sex partners who have had sexual contact with the patient within 60 days should be tested for gonorrhea and other STIs and treated if results are positive. […] Expedited partner therapy (EPT) involves giving patients a prescription or medications to deliver to their partner. EPT may enhance partner adherence and reduce treatment failure due to reinfection.

• #22 Gonorrhea – Wikipedia

  https://en.wikipedia.org/wiki/Gonorrhea

  Treatment is usually with ceftriaxone by injection and azithromycin by mouth. […] However, due to increasing rates of antibiotic resistance, local susceptibility patterns must be taken into account when deciding on treatment. […] Ertapenem is a potential effective alternative treatment for ceftriaxone-resistant gonorrhea. […] It is recommended that sexual partners be tested and potentially treated. […] The United States’ Centers for Disease Control and Prevention (CDC) currently recommend that individuals who have been diagnosed and treated for gonorrhea avoid sexual contact with others until at least one week past the final day of treatment in order to prevent the spread of the bacterium. […] Many antibiotics that were once effective including penicillin, tetracycline, and fluoroquinolones are no longer recommended because of high rates of resistance.

• #23 Gonorrhea – Wikipedia

  https://en.wikipedia.org/wiki/Gonorrhea

  Resistance to cefixime has reached a level such that it is no longer recommended as a first-line agent in the United States, and if it is used a person should be tested again after a week to determine whether the infection still persists. […] In 2016, the WHO published new guidelines for treatment, stating „There is an urgent need to update treatment recommendations for gonococcal infections to respond to changing antimicrobial resistance (AMR) patterns of N. gonorrhoeae.”

• #24 Future treatment of gonorrhoea – novel emerging drugs are essential and in progress?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4550495/

  Gonorrhoea is a major public health concern, causing significant morbidity and socioeconomic consequences globally. Neisseria gonorrhoeae has developed antimicrobial resistance (AMR) to all drugs available for treating gonorrhoea. In most countries, the only option for first-line empirical antimicrobial monotherapy is the extended-spectrum cephalosporin (ESC) ceftriaxone. Rare treatment failures of pharyngeal gonorrhoea with ceftriaxone and emergence of gonococcal strains exhibiting high-level clinical ESC resistance, combined with resistance to nearly all other antimicrobials, have resulted in development of global and regional action/ response plans, and introduction of dual antimicrobial therapy (ceftriaxone 250 500 mg and azithromycin 1 2 g) in Europe, the USA and additional countries. However, the susceptibility of gonococcal strains to ceftriaxone has decreased globally, resistance to azithromycin is already prevalent in many settings and concomitant resistance to both ceftriaxone and azithromycin has been identified in several settings. Consequently, these dual antimicrobial regimens might not be long-term solutions. Improved treatment and novel therapeutic antimicrobials are essential.

• #25 Gonorrhea: Causes, Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/4217-gonorrhea

  Taking all antibiotics as prescribed is always important, but it’s especially important with gonorrhea. Gonorrhea is curable now, but it’s becoming more resistant to antibiotics. Some forms of gonorrhea that have developed a high level of antibiotic resistance are commonly referred to as super gonorrhea. […] Gonorrhea infection clears up within seven to 14 days after treatment with antibiotics. Some healthcare providers recommend a second gonorrhea test to make sure the infection is completely gone.

• #26 Future treatment of gonorrhoea – novel emerging drugs are essential and in progress?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4550495/

  The dual antimicrobial treatment regimens with ceftriaxone and azithromycin are currently highly effective, however, as mentioned above these regimens might not be long-term solutions. Novel affordable treatments and/or antimicrobials for monotherapy or inclusion in dual treatment regimens, which might need to where feasible be considered for all newly developed antimicrobials, are essential. A recent study evaluated two different novel dual antimicrobial regimens, that is, gentamicin (240 mg) plus azithromycin (2 g) and gemifloxacin (320 mg) plus azithromycin (2 g), for treatment of uncomplicated gonorrhoea. Microbiological cure was 100% with gentamicin + azithromycin and 99.5% with gemifloxacin + azithromycin, but adverse events were frequent with both regimens. Generally, for dual antimicrobial therapy additional research is crucial to determine which antimicrobials (at what dosages) could be combined, and to appropriately document efficacy, side effects, pharmacokinetic/pharmacodynamic parameters, in vitro and in vivo synergistic relationship between antimicrobials, suppression of or increased resistance emergence (in gonococci and bystander organisms) and microbiological resistance breakpoints.

• #27 Future treatment of gonorrhoea – novel emerging drugs are essential and in progress?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4550495/

  From a global public health perspective, where dual therapy is not affordable or feasible due to other reasons an effective antimicrobial monotherapy remain exceedingly valuable. Old antimicrobials such as the aminocyclitol spectinomycin, aminoglycoside gentamicin, fosfomycin and carbapenem ertapenem have been suggested and the in vitro susceptibility to all these appears relatively high. However, for empirical monotherapy all of these antimicrobials have shortcomings, for example, resistance is easily selected or resistance/decreased susceptibility already exist (spectinomycin, fosfomycin, ertapenem), mainly no recent appropriate clinical efficacy data for empiric monotherapy of urogenital and particularly extragenital gonorrhoea (gentamicin [mainly used in combination with doxycycline in Malawi], fosfomycin and ertapenem), evidenced suboptimal efficacy for treatment of pharyngeal gonorrhoea (spectinomycin) and lack of evidence-based correlates between MICs, pharmacokinetic/pharmacodynamic parameters and gonorrhoea treatment outcome (gentamicin, fosfomycin and ertapenem). Consequently, these antimicrobials are most likely mainly options for salvage therapy of ceftriaxone-resistant gonorrhoea and/or in novel dual antimicrobial treatment regimens.

• #28

  https://www.nbcnews.com/health/health-news/new-antibiotic-drug-resistant-gonorrhea-treatment-study-rcna201053

  A pill developed by GSK was found to be safe and effective in treating gonorrhea in a late-stage clinical trial, according to a study published Monday in The Lancet. […] A new treatment option is important, experts say, because bacteria that commonly cause STIs are increasingly becoming resistant to the standard antibiotics, making treatment more difficult. […] Gonorrhea has developed resistance to nearly all the antibiotics used for its treatment, according to the CDC. […] Gepotidacin is part of a new class of antibiotics called triazaacenaphthylenes, which work by targeting two key enzymes that gonorrhea needs to copy itself and survive. […] Crucially, the study authors wrote, the pill was effective against strains of gonorrhea bacteria that are resistant to existing antibiotics.

• #29 Future treatment of gonorrhoea – novel emerging drugs are essential and in progress?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4550495/

  Clearly, novel antimicrobial targets, compounds and treatment strategies are essential to develop and evaluate. Therapeutic compounds with multiple targets might be important to suppress resistance emergence, however, further research is important to provide an appropriate evidence base for this. Interestingly, several antimicrobials or other compounds, using new targets or bactericidal or bacteriostatic strategies, have been designed in recent years. Several of these have also shown a high in vitro activity against gonococcal isolates. Some examples of these are new protein synthesis inhibitors such as pleuromutilin BC-3781 and the boron-containing inhibitor AN3365; LpxC inhibitors; species-specific FabI inhibitors such as MUT056399 and novel inhibitors of bacterial topoisomerases that target regions different from the fluoroquinolone-binding sites such as VT12-008911 and AZD0914. An open-label, randomized, multicenter Phase II clinical trial is also currently recruiting participants with uncomplicated gonorrhoea. The study aims to enroll 180 participants and treatment with AZD0914 2 g orally and AZD0914 3 g orally will be evaluated with ceftriaxone 500 mg as the active comparator.

• #30 Future treatment of gonorrhoea – novel emerging drugs are essential and in progress?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4550495/

  Future treatment must be in strict accordance with regularly updated management guidelines, which should be informed by quality assured surveillance of local AMR and treatment failures. Dual antimicrobial therapy (ceftriaxone and azithromycin), which also eradicates any concurrent chlamydial infection, should be considered in all settings where local quality assured AMR data do not support other therapeutic options. Nevertheless, in some settings compliance with therapy is a limited problem and, when evaluated, multiple doses of a single antimicrobial might also be considered in the future. Appropriate pharmacokinetic/pharmacodynamic simulations and clinical studies for both currently used and novel antimicrobials would be exceedingly valuable and, preferably, both monotherapy and dual therapy of urogenital and extragenital gonorrhoea with different combinations of antimicrobials and multiple doses, should be evaluated.

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