{"id":1296,"date":"2017-06-28T17:48:33","date_gmt":"2017-06-28T16:48:33","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1296"},"modified":"2017-11-01T15:24:18","modified_gmt":"2017-11-01T15:24:18","slug":"can-laboratory-guided-treatment-of-gonorrhoea-with-ciprofloxacin-help-to-stem-the-emergence-of-resistance-to-ceftiaxone","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2017\/06\/28\/can-laboratory-guided-treatment-of-gonorrhoea-with-ciprofloxacin-help-to-stem-the-emergence-of-resistance-to-ceftiaxone\/","title":{"rendered":"Can laboratory-guided treatment of gonorrhoea with ciprofloxacin help to stem the emergence of resistance to ceftiaxone?"},"content":{"rendered":"

With antimicrobial-resistant gonorrhoea now an urgent health threat, requiring improved antibiotic stewardship, one option frequently proposed is laboratory-guided recycling of older antibiotics (Lewis (STI)<\/a>; Ison & Unemo (STI)<\/a>; A new kind of treatment for gonorrhoea? (STI\/blogs)<\/a>).\u00a0 Lewis (STI)<\/a> alludes to the potential use of floroquinolone therapy \u2013 specifically in respect to the oropharyngx, which is the site at which treatment failure is most likely to occur.\u00a0 Epidemiological typing to detect markers associated with antibiotic resistance makes this kind of intervention a real possibility (Graham & Jennison (STI)<\/a>.<\/p>\n

Lao-tzu & Klausner<\/a> (L&K) have recently reported a trial that claims to demonstrate the feasibility of just the kind of therapy envisaged by Lewis.\u00a0 The researchers at University of California Los Angeles (UCLA) Health Clinical Microbiology Laboratory developed and implemented a molecular assay for the prediction of gonorrhoea (Ng) ciprofloxacin susceptibility.\u00a0 Over the period from November 2015 to July 2016 all Ng positive specimens were subjected to the assay, and treatment recommendations issued on that basis.\u00a0 In the final two months (June-July 2016) electronic reminder notifications were introduced \u2013 and it was only at that point that the intervention had any substantial impact on the treatment of patients.<\/p>\n

Of the 176 infections detected, 121 (69%) were successfully genotyped.\u00a0 Of the latter, 72 (60%<\/strong>) showed wild-type gyr<\/em>A (the gene associated with antimicrobial resistance, 49 (40%<\/strong>) were mutant.\u00a0 In the final successful two-month phase of assay implementation, this enabled 9 out of 11 (82%<\/strong>) of Ng infections to be treated with ciprofloxacin. The authors claim this shows the potential for laboratory-guided treatment of floroquinolones to limit recourse to ceftriaxone \u2013 and thereby slow the emergence of antibiotic resistant Ng.\u00a0 Clearly, the trial needs to be run again, but this time using electronic reminder notifications from the start.<\/p>\n

When it comes to the more specific issue of antimicrobial resistance to Ng at the oropharyngeal site, the results of the study are less promising. The proportion of gyr<\/em>A mutant Ng infections did not vary significantly by site (pharyngeal 33%; rectal 45.7%; vaginal\/cervical 57%; urine 39%); but of the 62 pharyngeal infections, most (40<\/strong>) could not be genotyped.\u00a0 So laboratory-guided ciprofloxacin treatment would be of limited usefulness in key populations \u2013 such as MSM.<\/p>\n","protected":false},"excerpt":{"rendered":"

With antimicrobial-resistant gonorrhoea now an urgent health threat, requiring improved antibiotic stewardship, one option frequently proposed is laboratory-guided recycling of older antibiotics (Lewis (STI); Ison & Unemo (STI); A new kind of treatment for gonorrhoea? (STI\/blogs)).\u00a0 Lewis (STI) alludes to the potential use of floroquinolone therapy \u2013 specifically in respect to the oropharyngx, which is […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4353,2788,2103,16509],"tags":[],"class_list":["post-1296","post","type-post","status-publish","format-standard","hentry","category-antimicrobial-resistance","category-antimicrobials","category-gonorrhoea","category-multi-resistant-gonorrhoea"],"yoast_head":"\nCan laboratory-guided treatment of gonorrhoea with ciprofloxacin help to stem the emergence of resistance to ceftiaxone? - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2017\/06\/28\/can-laboratory-guided-treatment-of-gonorrhoea-with-ciprofloxacin-help-to-stem-the-emergence-of-resistance-to-ceftiaxone\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Can laboratory-guided treatment of gonorrhoea with ciprofloxacin help to stem the emergence of resistance to ceftiaxone? - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"With antimicrobial-resistant gonorrhoea now an urgent health threat, requiring improved antibiotic stewardship, one option frequently proposed is laboratory-guided recycling of older antibiotics (Lewis (STI); Ison & Unemo (STI); A new kind of treatment for gonorrhoea? 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