Comment on: High levels of susceptibility to new and older antibiotics in Neisseria gonorrhoeae isolates from Saskatchewan (2003–15): time to consider point-of-care or molecular testing for precision treatment?

Comment on: High levels of susceptibility to new and older antibiotics in Neisseria gonorrhoeae... Sir, We read with interest the article by Thakur et al.1 reporting that Neisseria gonorrhoeae isolates from Canada were largely susceptible (about 85%) to antimicrobial therapy no longer indicated for its treatment. Currently, physicians are experiencing relapse and failure due to the increase in infections caused by gonococci with reduced susceptibility to cephalosporins,2 which are the recommended therapy. Therefore repurposing old drugs such as penicillin and ciprofloxacin as suggested by Thakur et al.1 might be of interest. Moreover, Davido et al.3 support this idea and highlighted that aztreonam might be helpful, especially in case of allergy to β-lactams or when the patient is suspected of resistance. Yet aztreonam has not been taken into account in the latest guidelines for the treatment of gonorrhoea. Indeed, the latest review of the literature issued by the US CDC in 1995,4 which served as a baseline, did not retain aztreonam as a highly effective drug against gonorrhoea because of lack of efficacy against pharyngeal infection (66.6%), although this finding was based on a very small sample size (n = 3).5 Since this publication, no new data have become available in order to assess adequately the efficacy of aztreonam, especially because fluoroquinolones and cephalosporins have been widely used in the treatment of gonorrhoea in the last two decades. Currently, WHO tolerates a resistance rate up to 5% for the molecules that can be used to treat gonorrhoea,6 which is exactly what aztreonam fulfils. In 1983, the first report of single-dose aztreonam treatment in acute uncomplicated gonococcal urethritis in men reported 100% efficacy.7 In 1992, one in vitro study revealed that, among 333 gonococcal isolates, none was resistant to aztreonam (MIC <8 mg/L).8 More recently, some strains of N. gonorrhoeae with reduced susceptibility to ceftriaxone [H041 (MIC 2 mg/L), F89 (MIC 1 mg/L) and A8806/G140106 (MIC 0.5 mg/L)] have been described, but none was tested against aztreonam.9,10 One major concern about using aztreonam in practice is that EUCAST breakpoints are not defined for the use of aztreonam against N. gonorrhoeae isolates.11 Nevertheless, as Thakur et al.1 reminded us, gonorrhoea is mostly diagnosed by PCR testing, which does not permit antimicrobial susceptibility testing. It is of note that aztreonam has the same route of administration as ceftriaxone, but has the advantage of a lack of disturbance of the gut flora due to lower biliary excretion (<1%) than ceftriaxone (45%), as mentioned in the summary of product characteristics. Altogether, we believe that the data presented by Thakur et al.1 together with those by Davido et al.3 support the rethinking of the management of gonococcal infections, especially when patients are infected by strains with reduced susceptibility to ceftriaxone or are known to be allergic to β-lactams. Acknowledgements We would like to thank all our colleagues, in particular Azzam Saleh-Mghir and Dr Pierre De Truchis, for their unfailing support. Transparency declarations None to declare. References 1 Thakur SD, Levett PN, Horsman GB et al.   High levels of susceptibility to new and older antibiotics in Neisseria gonorrhoeae isolates from Saskatchewan (2003–15): time to consider point-of-care or molecular testing for precision treatment? J Antimicrob Chemother  2018; 73: 118– 25. Google Scholar CrossRef Search ADS PubMed  2 Yu R, Yin Y, Wang G et al.   Worldwide susceptibility rates of Neisseria gonorrhoeae isolates to cefixime and cefpodoxime: a systematic review and meta-analysis. PLoS One  2014; 9: e87849. Google Scholar CrossRef Search ADS PubMed  3 Davido B, Dinh A, Senard O et al.   Repurposing an old drug: aztreonam as a new treatment strategy for gonorrhoea. J Antimicrob Chemother  2017; 72: 1466– 8. Google Scholar PubMed  4 Moran JS, Levine WC. Drugs of choice for the treatment of uncomplicated gonococcal infections. Clin Infect Dis  1995; 20 Suppl 1: S47– 65. Google Scholar CrossRef Search ADS PubMed  5 Tait IB, Winning J, Sleigh JD. Single dose aztreonam in treating gonorrhoea. Genitourin Med  1987; 63: 13– 5. Google Scholar PubMed  6 WHO. WHO Guidelines for the Treatment of Neisseria gonorrhoeae . Geneva, Switzerland: WHO, 2016. http://apps.who.int/iris/bitstream/10665/246114/1/9789241549691-eng.pdf. 7 Miller LK, Sanchez PL, Berg SW et al.   Effectiveness of aztreonam, a new monobactam antibiotic, against penicillin-resistant gonococci. J Infect Dis  1983; 148: 612. Google Scholar CrossRef Search ADS PubMed  8 Clendennen TE, Echeverria P, Saengeur S et al.   Antibiotic susceptibility survey of Neisseria gonorrhoeae in Thailand. Antimicrob Agents Chemother  1992; 36: 1682– 7. Google Scholar CrossRef Search ADS PubMed  9 Deguchi T, Yasuda M, Hatazaki K et al.   New clinical strain of Neisseria gonorrhoeae with decreased susceptibility to ceftriaxone, Japan. Emerg Infect Dis  2016; 22: 142– 4. Google Scholar CrossRef Search ADS PubMed  10 Lahra MM, Ryder N, Whiley DM. A new multidrug-resistant strain of Neisseria gonorrhoeae in Australia. N Engl J Med  2014; 371: 1850– 1. Google Scholar CrossRef Search ADS PubMed  11 EUCAST. Breakpoint Tables for Interpretation of MICs and Zone Diameters, Version 7.1, 2017. http://www.eucast.org. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Antimicrobial Chemotherapy Oxford University Press

Comment on: High levels of susceptibility to new and older antibiotics in Neisseria gonorrhoeae isolates from Saskatchewan (2003–15): time to consider point-of-care or molecular testing for precision treatment?

Loading next page...
 
/lp/ou_press/comment-on-high-levels-of-susceptibility-to-new-and-older-antibiotics-TxkkFvZ0YQ
Publisher
Oxford University Press
Copyright
© The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
ISSN
0305-7453
eISSN
1460-2091
D.O.I.
10.1093/jac/dkx408
Publisher site
See Article on Publisher Site

Abstract

Sir, We read with interest the article by Thakur et al.1 reporting that Neisseria gonorrhoeae isolates from Canada were largely susceptible (about 85%) to antimicrobial therapy no longer indicated for its treatment. Currently, physicians are experiencing relapse and failure due to the increase in infections caused by gonococci with reduced susceptibility to cephalosporins,2 which are the recommended therapy. Therefore repurposing old drugs such as penicillin and ciprofloxacin as suggested by Thakur et al.1 might be of interest. Moreover, Davido et al.3 support this idea and highlighted that aztreonam might be helpful, especially in case of allergy to β-lactams or when the patient is suspected of resistance. Yet aztreonam has not been taken into account in the latest guidelines for the treatment of gonorrhoea. Indeed, the latest review of the literature issued by the US CDC in 1995,4 which served as a baseline, did not retain aztreonam as a highly effective drug against gonorrhoea because of lack of efficacy against pharyngeal infection (66.6%), although this finding was based on a very small sample size (n = 3).5 Since this publication, no new data have become available in order to assess adequately the efficacy of aztreonam, especially because fluoroquinolones and cephalosporins have been widely used in the treatment of gonorrhoea in the last two decades. Currently, WHO tolerates a resistance rate up to 5% for the molecules that can be used to treat gonorrhoea,6 which is exactly what aztreonam fulfils. In 1983, the first report of single-dose aztreonam treatment in acute uncomplicated gonococcal urethritis in men reported 100% efficacy.7 In 1992, one in vitro study revealed that, among 333 gonococcal isolates, none was resistant to aztreonam (MIC <8 mg/L).8 More recently, some strains of N. gonorrhoeae with reduced susceptibility to ceftriaxone [H041 (MIC 2 mg/L), F89 (MIC 1 mg/L) and A8806/G140106 (MIC 0.5 mg/L)] have been described, but none was tested against aztreonam.9,10 One major concern about using aztreonam in practice is that EUCAST breakpoints are not defined for the use of aztreonam against N. gonorrhoeae isolates.11 Nevertheless, as Thakur et al.1 reminded us, gonorrhoea is mostly diagnosed by PCR testing, which does not permit antimicrobial susceptibility testing. It is of note that aztreonam has the same route of administration as ceftriaxone, but has the advantage of a lack of disturbance of the gut flora due to lower biliary excretion (<1%) than ceftriaxone (45%), as mentioned in the summary of product characteristics. Altogether, we believe that the data presented by Thakur et al.1 together with those by Davido et al.3 support the rethinking of the management of gonococcal infections, especially when patients are infected by strains with reduced susceptibility to ceftriaxone or are known to be allergic to β-lactams. Acknowledgements We would like to thank all our colleagues, in particular Azzam Saleh-Mghir and Dr Pierre De Truchis, for their unfailing support. Transparency declarations None to declare. References 1 Thakur SD, Levett PN, Horsman GB et al.   High levels of susceptibility to new and older antibiotics in Neisseria gonorrhoeae isolates from Saskatchewan (2003–15): time to consider point-of-care or molecular testing for precision treatment? J Antimicrob Chemother  2018; 73: 118– 25. Google Scholar CrossRef Search ADS PubMed  2 Yu R, Yin Y, Wang G et al.   Worldwide susceptibility rates of Neisseria gonorrhoeae isolates to cefixime and cefpodoxime: a systematic review and meta-analysis. PLoS One  2014; 9: e87849. Google Scholar CrossRef Search ADS PubMed  3 Davido B, Dinh A, Senard O et al.   Repurposing an old drug: aztreonam as a new treatment strategy for gonorrhoea. J Antimicrob Chemother  2017; 72: 1466– 8. Google Scholar PubMed  4 Moran JS, Levine WC. Drugs of choice for the treatment of uncomplicated gonococcal infections. Clin Infect Dis  1995; 20 Suppl 1: S47– 65. Google Scholar CrossRef Search ADS PubMed  5 Tait IB, Winning J, Sleigh JD. Single dose aztreonam in treating gonorrhoea. Genitourin Med  1987; 63: 13– 5. Google Scholar PubMed  6 WHO. WHO Guidelines for the Treatment of Neisseria gonorrhoeae . Geneva, Switzerland: WHO, 2016. http://apps.who.int/iris/bitstream/10665/246114/1/9789241549691-eng.pdf. 7 Miller LK, Sanchez PL, Berg SW et al.   Effectiveness of aztreonam, a new monobactam antibiotic, against penicillin-resistant gonococci. J Infect Dis  1983; 148: 612. Google Scholar CrossRef Search ADS PubMed  8 Clendennen TE, Echeverria P, Saengeur S et al.   Antibiotic susceptibility survey of Neisseria gonorrhoeae in Thailand. Antimicrob Agents Chemother  1992; 36: 1682– 7. Google Scholar CrossRef Search ADS PubMed  9 Deguchi T, Yasuda M, Hatazaki K et al.   New clinical strain of Neisseria gonorrhoeae with decreased susceptibility to ceftriaxone, Japan. Emerg Infect Dis  2016; 22: 142– 4. Google Scholar CrossRef Search ADS PubMed  10 Lahra MM, Ryder N, Whiley DM. A new multidrug-resistant strain of Neisseria gonorrhoeae in Australia. N Engl J Med  2014; 371: 1850– 1. Google Scholar CrossRef Search ADS PubMed  11 EUCAST. Breakpoint Tables for Interpretation of MICs and Zone Diameters, Version 7.1, 2017. http://www.eucast.org. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Journal

Journal of Antimicrobial ChemotherapyOxford University Press

Published: Mar 1, 2018

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off