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Challenges with gonorrhea in the era of multi-drug and extensively drug resistance -are we on the right track?
Örebro University Hospital. National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-1710-2081
National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.
Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta GA, United States; Laboratories of Bacterial Pathogenesis, Veterans Affairs Medical Center, Decatur GA, United States.
2014 (English)In: Expert Review of Anti-Infective Therapy, ISSN 1478-7210, E-ISSN 1744-8336, Vol. 12, no 6, p. 653-656Article in journal (Refereed) Published
Abstract [en]

Neisseriagonorrhoeae has retained antimicrobial resistance to drugs previously recommended for first-line empiric treatment of gonorrhea, and resistance to ceftriaxone, the last option for monotherapy, is evolving. Crucial actions to combat this developing situation include implementing response plans; considering use of dual antimicrobial regimens; enhancing surveillance of gonorrhea, gonococcal antimicrobial resistance, treatment failures and antimicrobial use/misuse and improving prevention, early diagnosis, contact tracing and treatment. The ways forward also include an intensified research to identify novel antimicrobial resistance determinants and develop and evaluate appropriate use of molecular antimicrobial resistance testing, ideally point-of-care and with simultaneous detection of gonococci, to supplement culture-based methods and ideally guide tailored treatment. It is crucial with an enhanced understanding of the dynamics of the national and international emergence, transmission and evolution of antimicrobial-resistant gonococcal strains. Genome sequencing combined with epidemiological metadata will detail these issues and might also revolutionize the molecular antimicrobial resistance testing. Ultimately, novel antimicrobials are essential and some antimicrobials in development have shown potent in vitro activity against gonococci. Several of these antimicrobials deserve further attention for potential future treatment of gonorrhea.

Place, publisher, year, edition, pages
Expert reviews , 2014. Vol. 12, no 6, p. 653-656
Keywords [en]
antimicrobial resistance, cefixime, ceftriaxone, gonorrhea, Neisseria gonorrhoeae, surveillance, treatment, WHO
National Category
Pharmacology and Toxicology
Identifiers
URN: urn:nbn:se:oru:diva-56776DOI: 10.1586/14787210.2014.906902ISI: 000335964800002PubMedID: 24702589Scopus ID: 2-s2.0-84901020224OAI: oai:DiVA.org:oru-56776DiVA, id: diva2:1084062
Note

Funding Agency:

NIAID NIH HHS R37 AI021150  U19 AI031496  R01 AI021150

Available from: 2017-03-23 Created: 2017-03-23 Last updated: 2018-06-24Bibliographically approved

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