{"id":997,"date":"2014-05-14T15:23:50","date_gmt":"2014-05-14T15:23:50","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=997"},"modified":"2014-05-10T15:58:40","modified_gmt":"2014-05-10T15:58:40","slug":"gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2014\/05\/14\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\/","title":{"rendered":"Gonorrhoea antimicrobial resistance: is UK antibiotic stewarding policy shows \u201csome success\u201d"},"content":{"rendered":"<p>A widely circulated <a href=\"http:\/\/www.medicalnewstoday.com\/releases\/275529.php\">press release<\/a> from the Society of General Microbiology\u2019s (SGM) Annual Conference 2014 (April 14<sup>th<\/sup> &#8211; 17<sup>th<\/sup>) reports that Health for England\u2019s Gonorrhoea Resistance Action Plan, according to representative, Dr Catherine Ison, \u201chas shown some success in delaying the onset of treatment failure to the oral antibiotic cefixime\u201d.\u00a0 At issue here is the policy of switching to intra-muscular ceftriaxone with azithromycin as the first line treatment for gonorrhoea in the face of alarming evidence of an increase in gonococcal resistance to oral cefixime &#8211; a policy that aims to delay the emergence of cefixime resistance, and so \u201csteward\u201d our last remaining antibiotic defences against the infection (<a href=\"https:\/\/blogs.bmj.com\/sti\/2013\/08\/09\/stewarding-may-be-the-best-policy-for-prolonging-the-efficacy-of-anti-gonorrhoea-drugs\/?preview=true&amp;preview_id=886&amp;preview_nonce=1f2569d3d1\">STI\/blogs\/Ison &amp; Lowndes<\/a>).<\/p>\n<p>So the reprieve continues, we are to assume &#8211; in the absence from the press-release of even a head-line figure in support of Ison\u2019s bare claim to \u201csome success\u201d.\u00a0 If we turn to the Gonococcal Resistance to Antimicrobials Surveillance Programme\u2019s last report (<a href=\"http:\/\/www.hpa.org.uk\/webc\/HPAwebFile\/HPAweb_C\/1317140152190\">GRASP 2012<\/a>: published October 2013) we find that the prevalence of GUM isolates exhibiting decreased susceptibility to cefixime (MIC \u22650.125 mg\/L) declined significantly in MSM from <strong>17%<\/strong> in 2011 to <strong>7%<\/strong> in 2012, and in females from <strong>3%<\/strong> in 2011 to <strong>1.6%<\/strong> in 2012 (though isolates from heterosexual men show little change in cefixime MICs), following alarming increases in resistance from 2007-2010. In June 2013, <a href=\"http:\/\/ac.els-cdn.com\/S1473309913701439\/1-s2.0-S1473309913701439-main.pdf?_tid=d65d9132-d38b-11e3-ad56-00000aacb362&amp;acdnat=1399208510_f813ea1943b3f66d3b8a542e43b78f72\">Ison &amp; Lowndes<\/a> (I&amp;L) (<a href=\"https:\/\/blogs.bmj.com\/sti\/2013\/08\/09\/stewarding-may-be-the-best-policy-for-prolonging-the-efficacy-of-anti-gonorrhoea-drugs\/?preview=true&amp;preview_id=886&amp;preview_nonce=1f2569d3d1\">STI\/blogs\/Ison &amp; Lowndes<\/a>) noted a \u201cstriking association\u201d between this decline in resistance and the change in UK prescribing practice referred to above, though \u201ccausality cannot be attributed to this observation\u201d (<a href=\"http:\/\/www.thedoctorschannel.com\/view\/gonorrhea-uks-proactive-prescribing-changes-keeping-antibiotic-resistance-at-bay\/\">Ison: Doctor&#8217;s Channel<\/a>).\u00a0 (Any argument for causality would, as a minimum, require precise information regarding the timing of the policy change &#8211; which is conspicuously absent from the I&amp;L paper). \u00a0The SGM press-release appears to indicate a continuation of the same downward trend, and presumably offers further endorsement for the policy adopted at some point in 2011.<\/p>\n<p>The SGM devoted a Report to sexually transmitted infections in 2013 (<a href=\"http:\/\/www.sgm.ac.uk\/en\/policy\/position-statements.cfm\/publication\/2013-sexually-transmitted-infections\">SGM &#8211; 2013<\/a>). <em>Anti-microbial resistance <\/em>(most urgently, at present, in gonorrhoea) heads the list of three research challenges.\u00a0 Recommendations include investment in research to track the impact of new interventions (e.g. optimizing the use of existing antibiotics), and extending lessons learned on gonorrhoea to understand treatment failure in chlamydia and mycoplasma genitalium &#8211; as well, of course, as initiating a drug development strategy that addresses the current problems of market failure.\u00a0 Interestingly, however, the second challenge, that of <em>rapid diagnosis of bacterial STIs<\/em>, is also highly relevant to the problem of stewarding antibiotic defences.\u00a0 The future development of enhanced diagnostic point-of-care tests based on genomic rapid sequencing techniques could enable a more \u201ctailored\u201d response to infection, based on profiling antibiotic susceptibility in the individual case, which would facilitate switching back to \u201cabandoned\u201d antibiotics where the their resistance profile disappears from the local population.<\/p>\n<p>Needless to say, the development of new antibiotics (potentially Cempra\u2019s solithromycin or AstraZeneca\u2019s AZD0914), and of rapid sequencing-based diagnostic techniques, are in the future.\u00a0 Meantime, the reprieve achieved through stewarding of cephalosporins may, says Ison, be short-lived.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A widely circulated press release from the Society of General Microbiology\u2019s (SGM) Annual Conference 2014 (April 14th &#8211; 17th) reports that Health for England\u2019s Gonorrhoea Resistance Action Plan, according to representative, Dr Catherine Ison, \u201chas shown some success in delaying the onset of treatment failure to the oral antibiotic cefixime\u201d.\u00a0 At issue here is the [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2014\/05\/14\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4353,2103],"tags":[],"class_list":["post-997","post","type-post","status-publish","format-standard","hentry","category-antimicrobial-resistance","category-gonorrhoea"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Gonorrhoea antimicrobial resistance: is UK antibiotic stewarding policy shows \u201csome success\u201d - 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\/2014\/05\/14\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Gonorrhoea antimicrobial resistance: is UK antibiotic stewarding policy shows \u201csome success\u201d - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"A widely circulated press release from the Society of General Microbiology\u2019s (SGM) Annual Conference 2014 (April 14th &#8211; 17th) reports that Health for England\u2019s Gonorrhoea Resistance Action Plan, according to representative, Dr Catherine Ison, \u201chas shown some success in delaying the onset of treatment failure to the oral antibiotic cefixime\u201d.\u00a0 At issue here is the [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/sti\/2014\/05\/14\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\/\" \/>\n<meta property=\"og:site_name\" content=\"Sexually Transmitted Infections\" \/>\n<meta property=\"article:published_time\" content=\"2014-05-14T15:23:50+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/05\\\/14\\\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/05\\\/14\\\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Gonorrhoea antimicrobial resistance: is UK antibiotic stewarding policy shows \u201csome success\u201d\",\"datePublished\":\"2014-05-14T15:23:50+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/05\\\/14\\\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\\\/\"},\"wordCount\":515,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"articleSection\":[\"Antimicrobial resistance\",\"Gonorrhoea\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/05\\\/14\\\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/05\\\/14\\\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\\\/\",\"name\":\"Gonorrhoea antimicrobial resistance: is UK antibiotic stewarding policy shows \u201csome success\u201d - Sexually Transmitted Infections\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#website\"},\"datePublished\":\"2014-05-14T15:23:50+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/05\\\/14\\\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/05\\\/14\\\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/05\\\/14\\\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Gonorrhoea antimicrobial resistance: is UK antibiotic stewarding policy shows \u201csome success\u201d\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/\",\"name\":\"Sexually Transmitted Infections\",\"description\":\"Discussion and suggestion space for readers of STIs\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\",\"name\":\"Sexually Transmitted Infections\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/files\\\/2017\\\/10\\\/blog-logo-sti.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/files\\\/2017\\\/10\\\/blog-logo-sti.png\",\"width\":378,\"height\":34,\"caption\":\"Sexually Transmitted Infections\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#\\\/schema\\\/logo\\\/image\\\/\"}},{\"@type\":\"Person\",\"@id\":\"\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/author\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Gonorrhoea antimicrobial resistance: is UK antibiotic stewarding policy shows \u201csome success\u201d - Sexually Transmitted Infections","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/sti\/2014\/05\/14\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\/","og_locale":"en_US","og_type":"article","og_title":"Gonorrhoea antimicrobial resistance: is UK antibiotic stewarding policy shows \u201csome success\u201d - Sexually Transmitted Infections","og_description":"A widely circulated press release from the Society of General Microbiology\u2019s (SGM) Annual Conference 2014 (April 14th &#8211; 17th) reports that Health for England\u2019s Gonorrhoea Resistance Action Plan, according to representative, Dr Catherine Ison, \u201chas shown some success in delaying the onset of treatment failure to the oral antibiotic cefixime\u201d.\u00a0 At issue here is the [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/sti\/2014\/05\/14\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\/","og_site_name":"Sexually Transmitted Infections","article_published_time":"2014-05-14T15:23:50+00:00","twitter_card":"summary_large_image","twitter_misc":{"Written by":"","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/sti\/2014\/05\/14\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/sti\/2014\/05\/14\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\/"},"author":{"name":"","@id":""},"headline":"Gonorrhoea antimicrobial resistance: is UK antibiotic stewarding policy shows \u201csome success\u201d","datePublished":"2014-05-14T15:23:50+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/sti\/2014\/05\/14\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\/"},"wordCount":515,"publisher":{"@id":"https:\/\/blogs.bmj.com\/sti\/#organization"},"articleSection":["Antimicrobial resistance","Gonorrhoea"],"inLanguage":"en-US"},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/sti\/2014\/05\/14\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\/","url":"https:\/\/blogs.bmj.com\/sti\/2014\/05\/14\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\/","name":"Gonorrhoea antimicrobial resistance: is UK antibiotic stewarding policy shows \u201csome success\u201d - Sexually Transmitted Infections","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/sti\/#website"},"datePublished":"2014-05-14T15:23:50+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/sti\/2014\/05\/14\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/sti\/2014\/05\/14\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/sti\/2014\/05\/14\/gonorrhoea-antimicrobial-resistance-is-uk-antibiotic-stewarding-policy-shows-some-success\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/sti\/"},{"@type":"ListItem","position":2,"name":"Gonorrhoea antimicrobial resistance: is UK antibiotic stewarding policy shows \u201csome success\u201d"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/sti\/#website","url":"https:\/\/blogs.bmj.com\/sti\/","name":"Sexually Transmitted Infections","description":"Discussion and suggestion space for readers of STIs","publisher":{"@id":"https:\/\/blogs.bmj.com\/sti\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/sti\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/sti\/#organization","name":"Sexually Transmitted Infections","url":"https:\/\/blogs.bmj.com\/sti\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/sti\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/sti\/files\/2017\/10\/blog-logo-sti.png","contentUrl":"https:\/\/blogs.bmj.com\/sti\/files\/2017\/10\/blog-logo-sti.png","width":378,"height":34,"caption":"Sexually Transmitted Infections"},"image":{"@id":"https:\/\/blogs.bmj.com\/sti\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"","url":"https:\/\/blogs.bmj.com\/sti\/author\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/posts\/997","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/users\/152"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/comments?post=997"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/posts\/997\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/media?parent=997"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/categories?post=997"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/tags?post=997"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}