As cases of “ultra-drug resistant” genital gonorrhea increase around the world, researchers have found that a combination of two antibiotics could be an effective alternative for patients who do not respond to current treatment.
A research team from the University Hospitals of Birmingham, England, may have found a solution to fight resistant strains of gonorrhea, a sexually transmitted infection for which ceftriaxone, which is currently the main antibiotic treatment, proves to be of less and less effective.
In an article published in The Lancetthe researchers claim to have discovered that the combination of two antibiotics, gentamicin and azithromycin, proved to be particularly effective in patients who no longer respond to ceftriaxone, the treatment currently given as first-line treatment.
An infection that is increasingly resistant to treatment
Also called gonorrhea or “gonococcal disease”, gonorrhea is a sexually transmitted infection (STI), linked to a bacterial infection with Neisseria gonorrhea or “gonococcus”. Only caught by direct contact, this infection can, if left untreated, cause scarring of the urethra or “urethritis”. It can also affect the cervix, uterus, fallopian tubes, small pelvis and eye.
While antibiotics are still effective against gonorrhea in the majority of cases, scientists are concerned about the proliferation of strains resistant to ceftriaxone. Cases of resistant gonorrhea have thus been observed in Southeast Asia and disseminated as far as Europe, mainly because of sex tourism.
For Professor Jonathan Ross, chief investigator of the Birmingham trial, it was therefore urgent to find an antibiotic treatment to which the bacteria responsible for gonorrhea has not yet developed resistance. “Our trial found that gentamicin combined with azithromycin works almost as well as ceftriaxone and azithromycin for genital gonorrhea.” However, he says, this combination of antibiotics was found to be less effective against infections of the throat and rectum.
A cure rate of 91%
Conducted at 14 sexual health clinics in England, the clinical trial involved 720 participants randomly assigned to receive either injections of gentamicin or the current treatment of intravenous ceftriaxone. Both groups also received a single dose of oral azithromycin.
Overall, 98% of participants who received ceftriaxone had their gonorrhea cured, compared to 91% of those who received gentamicin, a difference of 7%.
Also, physicians are likely to continue to use ceftriaxone (plus azithromycin) as first-line therapy. However, with a 94% cure rate for genital gonorrhea, gentamicin could be useful when ceftriaxone treatment is not available or effective.
“It is very concerning that cases of treatment-resistant gonorrhea are now emerging worldwide. This research provides important new data that suggests that gentamicin with azithromycin could become a second-line treatment for patients who are resistant to ceftriaxone with this infectious disease,” says Professor Hywel Williams, director of the NHRI Health Technology Assessment Program, which funded the study.
A point of view shared by Professor Jonathan Ross. “We believe that ceftriaxone should remain the first-line treatment for gonorrhea, with gentamicin being an alternative, especially for patients with genital infection and those who are allergic or intolerant to ceftriaxone.” But, he says, “further research is needed to identify and test new alternatives to ceftriaxone for the treatment of gonorrhea.”
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