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Gonococcal antimicrobial resistance in the Western Pacific Region
  1. Monica M Lahra1,2,
  2. Ying-Ru Lo3,
  3. David M Whiley4,5
  1. 1Microbiology Department, South Eastern Area Laboratory Services, WHO Collaborating Centre for STD, The Prince of Wales Hospital, Sydney, New South Wales, Australia
  2. 2The School of Medical Sciences, The University of New South Wales, Sydney, New South Wales, Australia
  3. 3WHO Regional Office for the Western Pacific, United Nations Avenue, Manila, The Philippines
  4. 4Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Health Services, Queensland, Australia
  5. 5Queensland Children's Medical Research Institute, The University of Queensland, Queensland, Australia
  1. Correspondence to Professor Monica Lahra, Microbiology Department, SEALS, Neisseria Reference Laboratory and WHO Collaborating Centre for STD (WPR and SEAR), Level 4 Campus Building, The Prince of Wales Hospital, School of Medical Sciences, The University of New South Wales, Randwick, NSW 2031, Australia; monica.lahra{at}SESIAHS.health.nsw.gov.au

Abstract

Objective To outline the current situation of gonococcal antimicrobial resistance (AMR) in the Western Pacific region and factors that impact on this.

Background The Western Pacific region is densely populated with many living in poverty. There are high rates of infectious diseases, and a disproportionate burden of gonococcal disease. In many countries there is uncontrolled antimicrobial use: these are ideal conditions for the emergence of AMR.

Methods Gonococcal AMR in this region has been monitored for more than 20 years. Clinical isolates, predominantly from unselected patients attending sexually transmitted diseases clinics, are tested against a panel of antibiotics. Quality assurance and control strategies are in place.

Results There is widespread, high level resistance to penicillin and ciprofloxacin. Decreased susceptibility to ceftriaxone (MIC≥0.06 mg/L) is reported in high levels from some countries in the region. Low numbers of isolates tested in some countries reflect capacity for testing, and are suboptimal for surveillance.

Conclusion The raised MIC values to ceftriaxone, and the emergence and spread of ceftriaxone resistant strains regionally is alarming. Sustaining and enhancing surveillance is critical; however obtaining an adequate sample size is a long-standing issue. The implementation of molecular surveillance strategies could provide broader information on the spread and threat of AMR.

  • Antibiotic Resistance
  • Gonococci
  • Gonorrhoea
  • Surveillance

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