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- Title
Impact of Rapid Susceptibility Testing and Antibiotic Selection Strategy on the Emergence and Spread of Antibiotic Resistance in Gonorrhea.
- Authors
Tuite, Ashleigh R.; Gift, Thomas L.; Chesson, Harrell W.; Hsu, Katherine; Salomon, Joshua A.; Grad, Yonatan H.
- Abstract
<bold>Background: </bold>Increasing antibiotic resistance limits treatment options for gonorrhea. We examined the impact of a hypothetical point-of-care (POC) test reporting antibiotic susceptibility profiles on slowing resistance spread.<bold>Methods: </bold>A mathematical model describing gonorrhea transmission incorporated resistance emergence probabilities and fitness costs associated with resistance based on characteristics of ciprofloxacin (A), azithromycin (B), and ceftriaxone (C). We evaluated time to 1% and 5% prevalence of resistant strains among all isolates with the following: (1) empiric treatment (B and C), and treatment guided by POC tests determining susceptibility to (2) A only and (3) all 3 antibiotics.<bold>Results: </bold>Continued empiric treatment without POC testing was projected to result in >5% of isolates being resistant to both B and C within 15 years. Use of either POC test in 10% of identified cases delayed this by 5 years. The 3 antibiotic POC test delayed the time to reach 1% prevalence of triply-resistant strains by 6 years, whereas the A-only test resulted in no delay. Results were less sensitive to assumptions about fitness costs and test characteristics with increasing test uptake.<bold>Conclusions: </bold>Rapid diagnostics reporting antibiotic susceptibility may extend the usefulness of existing antibiotics for gonorrhea treatment, but ongoing monitoring of resistance patterns will be critical.
- Subjects
ANTIBIOTICS; DRUG resistance; GONORRHEA; CIPROFLOXACIN; AZITHROMYCIN; CEFTRIAXONE; DISEASE prevalence
- Publication
Journal of Infectious Diseases, 2017, Vol 216, Issue 9, p1141
- ISSN
0022-1899
- Publication type
journal article
- DOI
10.1093/infdis/jix450