Global Resistance of Neisseria gonorrhoeae

When Theory Becomes Reality

David A. Lewis

Disclosures

Curr Opin Infect Dis. 2014;27(1):62-67. 

In This Article

Novel Antimicrobial Treatment Options

Both ertapenem and solithromycin (CEM-101) appear to have reasonable in-vitro activity against ESC-resistant N. gonorrhoeae isolates.[42,43] However, the ertapenem MIC does increase in the presence of ESC-resistance-associated mutations.[42] This observation raises the possibility that further mutations in the penA gene could easily render this antimicrobial agent ineffective.[2] In addition, the fact that ertapenem is a parenteral 1-β-methyl-carbapenem makes it rather unsuitable for gonorrhoea treatment. Single-dose oral solithromycin, a fluoroketolide, is currently undergoing phase 2 safety and efficacy evaluation in patients with uncomplicated urogenital gonorrhoea. Solithromycin may be less prone to generate in-vivo resistance compared with other macrolides.[43,44] However, the presently circulating high-level macrolide resistant gonococci will be unlikely to respond to solithromycin. Tigecycline, a parenteral glycylcycline with activity against ESC-susceptible gonococci, has yet to be evaluated against ESC-resistant N. gonorrhoeae strains.[2]

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