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Scientists comparing gonorrhea treatments have identified a combination of drugs that could be an effective relief solution for patients who do not respond to current treatment.
The research team at Birmingham University Hospitals found that treatment with the antibiotic gentamicin with azithromycin works almost as well as ceftriaxone currently used for bad gonorrhea.
The study, funded by the National Institute of Health Research (NIHR), published in The lancet and is the first randomized controlled trial to compare the two treatments for badually transmitted infection in a context of concern regarding increasing resistance to ceftriaxone.
Public Health England (PHE) recently announced that it was investigating two cases of gonorrhea in two women with similar resistance profiles to the antibiotics ceftriaxone and azithromycin, which are used as first-line therapy.
One of these cases seems to have been contracted in Europe and the other, which has links to Europe, was acquired in the United Kingdom. A case of resistant gonorrhea was contracted in South-East Asia by a British national in 2018. This was a different and unrelated type of resistance.
Professor Jonathan Ross, chief investigator of the Birmingham trial, said: "Our current antibiotic treatment for gonorrhea is starting to fail and experience with previous drugs strongly suggests that this could become a widespread problem. Our trial showed that gentamicin badociated with azithromycin almost acted as well as ceftriaxone with azithromycin for bad gonorrhea, but did not clear throat or rectal gonorrhea as effectively.
"We believe that ceftriaxone should remain the first-line treatment for gonorrhea, with gentamicin being an alternative, especially for patients with bad infections, as well as patients with allergies or intolerance to ceftriaxone." Further research is needed to identify and test new alternatives to ceftriaxone treatment of gonorrhea. "
In a trial conducted in 14 badual health clinics in England, 720 participants were randomized to receive either gentamicin injections or current intravenous ceftriaxone therapy, both groups also receiving a single dose of Azithromycin orally.
Overall, 98% of participants receiving ceftriaxone cured their gonorrhea, compared to 91% of gentamicin, a difference of 7%. Therefore, it is likely that physicians will continue to use ceftriaxone (plus azithromycin) as the treatment of choice. Gentamicin had a cure rate of bad gonorrhea of 94%. It may be useful when ceftriaxone is not available or if its use is not appropriate.
The study also indicates that the commonly used treatment of azithromycin 1 gram, used in combination with both drugs, is probably not enough to prevent the development of resistance, and that its worldwide use as part of a dual-combination treatment for gonorrhea should be re-examined. In January of this year, the UK Association for Sexual Health and HIV changed the national guideline for the treatment of gonorrhea to suppress azithromycin (and use a higher dose of ceftriaxone instead) to reflect the results of the test.
If treated early, gonorrhea is unlikely to cause complications or long-term problems. However, without treatment, it can spread to other parts of the body and cause serious health problems.
In women, the infection can spread to the reproductive organs and cause pelvic inflammatory disease (PID). It is estimated that this occurs in 10 to 20% of cases of untreated gonorrhea. PID can lead to long-term pelvic pain, ectopic pregnancy, and infertility.
During pregnancy, the disease can cause miscarriage, premature delivery and the birth of a baby with conjunctivitis. If the baby is not treated quickly with antibiotics, there is a risk of developing an infection. progressive impairment of vision.
In men, gonorrhea can cause a painful infection of the testes and prostate.
Professor Hywel Williams, director of the NHRI's Health Technology Assessment Program, who funded the study, said: "It is very worrying that cases of treatment-resistant gonorrhea Worldwide, this research provides important new evidence suggesting that gentamicin-badociated azithromycin could become a second-line treatment for ceftriaxone-resistant patients with this infectious disease.
"The NHRI is engaged in research in areas where health needs are the greatest, such as antimicrobial resistance, and this research is one of the many studies we have funded in recent years. in this critical area, as part of our ongoing efforts to tackle this problem globally.
The researchers say that further research on the development of a preventive or therapeutic vaccine is crucial because of increasing resistance and future limited antibiotic options. They say that a better understanding of the immune response to infection is needed to develop this and that the collection of samples in the trial will contribute to this future research. It is also important to explore the frequency with which multiple infections occur and their potential role in the spread of resistance. Genome sequencing could help identify genetic markers of gonorrhea resistance and provide information on the mechanisms and predictors of resistance, they add.
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