Should we still use azithromycin for gonorrhoea treatment?

Mensforth, Sarah; Ross, Jonathan

doi:10.1071/sh19016

Cited by 10 publications

(5 citation statements)

References 73 publications

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“…3 Azithromycin 2 g more effectively cures azithromycin-susceptible gonococcal infections, compared to azithromycin 1 g. 115,128,143–145 However, azithromycin 2 g single oral dose also results in more gastrointestinal side effects, particularly if taken on empty stomach. 144,146,147 Most important, severe vomiting needs to be avoided before the azithromycin dose has been absorbed, i.e. in about one hour, which reduces the efficacy.…”

Section: Therapymentioning

confidence: 99%

Background review for the ‘2020 European guideline for the diagnosis and treatment of gonorrhoea in adults’

et al. 2020

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Gonorrhoea is a major public health concern globally. Increasing incidence and sporadic ceftriaxone-resistant cases, including treatment failures, are growing concerns. The 2020 European gonorrhoea guideline provides up-to-date evidence-based guidance regarding the diagnosis and treatment of gonorrhoea. The updates and recommendations emphasize significantly increasing gonorrhoea incidence; broad indications for increased testing with validated and quality-assured nucleic acid amplification tests (NAATs) and culture; dual antimicrobial therapy including high-dose ceftriaxone and azithromycin (ceftriaxone 1 g plus azithromycin 2 g) OR ceftriaxone 1 g monotherapy (ONLY in well-controlled settings, see guideline for details) for uncomplicated gonorrhoea when the antimicrobial susceptibility is unknown; recommendation of test of cure (TOC) in all gonorrhoea cases to ensure eradication of infection and identify resistance; and enhanced surveillance of treatment failures when recommended treatment regimens have been used. Improvements in access to appropriate testing, test performance, diagnostics, antimicrobial susceptibility surveillance and treatment, and follow-up of gonorrhoea patients are essential in controlling gonorrhoea and to mitigate the emergence and/or spread of ceftriaxone resistance and multidrug-resistant and extensively drug-resistant gonorrhoea. This review provides the detailed background, evidence base and discussions, for the 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults (Unemo M, et al. Int J STD AIDS. 2020).

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Section: Therapymentioning

confidence: 99%

Background review for the ‘2020 European guideline for the diagnosis and treatment of gonorrhoea in adults’

et al. 2020

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“…It is suggested that the oropharynx plays an important role in gonorrhoea transmission due to previously unrecognised practices such as kissing 6 – 9 . Furthermore, the oropharynx is also responsible for the emerging antimicrobial-resistant N. gonorrhoeae due to the poor antibiotic penetration into the oropharyngeal mucosa 10 , 11 .…”

Section: Introductionmentioning

confidence: 99%

An open-label, parallel-group, randomised controlled trial of antiseptic mouthwash versus antibiotics for oropharyngeal gonorrhoea treatment (OMEGA2)

Chow

Maddaford

Hocking

et al. 2020

Sci Rep

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New treatments for oropharyngeal gonorrhoea are required to address rising antimicrobial resistance. We aimed to examine the efficacy of a 14-day course of mouthwash twice daily compared to standard treatment (antibiotic) for the treatment of oropharyngeal gonorrhoea. The OMEGA2 trial was a parallel-group and open-labelled randomised controlled trial among men with untreated oropharyngeal gonorrhoea that was conducted between September 2018 and February 2020 at Melbourne Sexual Health Centre in Australia. Men were randomised to the intervention (rinsing, gargling and spraying mouthwash twice daily for 14 days) or control (standard treatment) arm and followed for 28 days. Participants in both arms were advised to abstain from sex and kissing with anyone for 14 days after enrolment. Oropharyngeal swabs were collected at baseline, Day 14 and Day 28 and tested for Neisseria gonorrhoeae by nucleic acid amplification test (NAAT) and culture. The primary outcome was the detection of oropharyngeal N. gonorrhoeae by NAAT at Day 14 after treatment. This trial was registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12618001380280). This trial stopped early due to a high failure rate in the mouthwash arm. Twelve men were randomly assigned to either mouthwash (n = 6) or standard treatment (n = 6). Of the 11 men who returned at Day 14, the cure rate for oropharyngeal gonorrhoea in the mouthwash arm was 20% (95% CI 1–72%; 1/5) and in the standard treatment arm was 100% (95% CI 54–100%; 6/6). A 14-day course of mouthwash failed to cure a high proportion of oropharyngeal gonorrhoea cases.

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“…For this review, we will focus on gonorrhoea treatment because treatment failures are higher at the oropharyngeal site compared to genital infections [115,116 ▪ ] and treatment options are becoming scarce as N. gonorrhoeae has developed resistance to all classes of antibiotics [86,117]. There is no global consensus on a single recommendation for oropharyngeal gonorrhoea treatment (Table 5) [118]. The Australian and European guidelines recommend dual therapy with single doses of ceftriaxone (500 mg to 1 g) and azithromycin 2 g [97,119], while the US and UK guidelines recommend ceftriaxone monotherapy (500 mg to 1 g single dose) as the first-line treatment (Table 5) [79,120,121].…”

Section: Treatment For Oropharyngeal Infectionsmentioning

confidence: 99%

STI pathogens in the oropharynx: update on screening and treatment

Chow,

Fairley,

Kong

2023

Current Opinion in Infectious Diseases

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Purpose of review The rise in antimicrobial resistance in several STI pathogens such as Neisseria gonorrhoeae has become a public health threat as only one first-line treatment remains. Reducing screening interval for gonorrhoea and chlamydia in high-prevalence populations has been proposed to address antimicrobial stewardship, but this remains controversial. This review aimed to revisit the epidemiology of infections at the oropharynx and review the current screening recommendations and treatment guidelines in different populations. Recent findings Emerging evidence suggests that the oropharynx is the primary anatomical site for gonorrhoea transmission but maybe not for chlamydia transmission. Most international guidelines recommend 3-monthly oropharyngeal gonorrhoea and chlamydia screening for high-prevalence populations (e.g. men who have sex with men) but not low-prevalence populations (e.g. heterosexuals) given the clinical and public health benefits of screening in low-prevalence populations are still unclear. Doxycycline remains the first-line treatment for oropharyngeal chlamydia in most guidelines. However, some countries have moved from dual therapy (ceftriaxone and azithromycin) to monotherapy (ceftriaxone) for oropharyngeal gonorrhoea treatment to address antimicrobial stewardship. Summary The transmission of gonorrhoea and chlamydia is still not fully understood. Further work will be required to evaluate the benefits and harms of reducing screening in high-prevalence populations.

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Should we still use azithromycin for gonorrhoea treatment?

Cited by 10 publications

References 73 publications

Background review for the ‘2020 European guideline for the diagnosis and treatment of gonorrhoea in adults’

Background review for the ‘2020 European guideline for the diagnosis and treatment of gonorrhoea in adults’

An open-label, parallel-group, randomised controlled trial of antiseptic mouthwash versus antibiotics for oropharyngeal gonorrhoea treatment (OMEGA2)

STI pathogens in the oropharynx: update on screening and treatment

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