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Point-of-care antibiotic susceptibility testing for gonorrhoea: improving therapeutic options and sparing the use of cephalosporins
  1. S T Sadiq1,
  2. J Dave2,
  3. P D Butcher1
  1. 1Centre for Infection, St George's, University of London, London, UK
  2. 2HPA Collaborating Centre, Medical Microbiology, St George's Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Syed Tariq Sadiq, Centre for Infection, St George's, University of London, London SW17 0RE, UK; ssadiq{at}sgul.ac.uk

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Antimicrobial therapy for Neiserria gonorrhoeae is a major public health concern with high rates of resistance to penicillin, tetracycline and fluoroquinolones detected in England and Wales in the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) (GRASP 2008 Report: Trends in Antimicrobial Resistant Gonorrhoea. Health Protection agency. http://www.hpa.org.uk/Publications/InfectiousDiseases/HIVAndSTIs/0906GRASP2008/ last accessed 26 July 2010). Currently, third-generation oral cephalosporins, such as cefixime or injectable ceftriaxone, are recommended as first-line therapy. However, low-level increases in minimum inhibitory concentrations (MIC) for cephalosporins are now widely reported,1 and reports of azithromycin resistance2 further highlight reduced therapeutic options. Recommendations to limit spread of cephalosporin resistance may well include combination and even prolonged therapy, but these undermine clinical desirability for a single observable dose.

However, there is still a significant local variation in resistance rates, and most circulating gonococcal strains continue to be susceptible to fluoroqunolones and penicillin in most settings. With the emergence of rapid diagnostic technologies for STIs and other infections, we ask whether point-of-care (PoC) antimicrobial susceptibility testing might soon be ready to exploit this aspect of gonococcal epidemiology. The answer will depend on: (1) current knowledge of the molecular basis of gonococcal resistance; (2) availability of molecular diagnostic platforms supporting detection of multiple molecular resistance markers; and (3) validation of these assays.

Recent progress in understanding mechanisms of gonococcal resistance has …

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