The WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO GASP), monitors trends in drug-resistant gonorrhoea. WHO GASP data from 2009 to 2014 indicate widespread resistance to ciprofloxacin (97% of countries that reported data in that period found drug-resistant strains), increasing resistance to azithromycin (81%), and the emergence of resistance to the current last-resort treatment: the extended-spectrum cephalosporins (ESCs) oral cefixime or injectable ceftriaxone (66%).
Currently, in most countries, ESCs are the only single antibiotic remaining effective for treating gonorrhoea. Resistance to cefixime - and more rarely to ceftriaxone - has now however been reported in more than 50 countries. As a result, WHO issued updated global treatment recommendations in 2016 advising doctors to give two antibiotics: ceftriaxone and azithromycin.
The research and development pipeline for gonorrhoea is relatively empty, with only three new candidate drugs in various stages of clinical development: solithromycin, for which a phase III trial has recently been completed; zoliflodacin, which has completed a phase II trial; and gepotidacin, which has also completed a phase II trial.
The development of new antibiotics is not very attractive for commercial pharmaceutical companies. Treatments are taken only for short periods of time (unlike medicines for chronic diseases) and they become less effective as resistance develops, meaning that the supply of new drugs constantly needs to be replenished.
The Drugs for Neglected Diseases initiative (DNDi) and WHO have launched the Global Antibiotic Research and Development Partnership (GARDP), a not-for-profit research and development organization, hosted by DNDi, to address this issue. GARDP’s mission is to develop new antibiotic treatments and promote appropriate use, so that they remain effective for as long as possible, while ensuring access for all in need. One of GARDP’s key priorities is the development of new antibiotic treatments for gonorrhoea. [Source: WHO News Release, 7 July 2017. http://www.who.int/mediacentre/news/releases/2017/Antibiotic-resistant-gono...]
In Scotland, antimicrobial resistance is monitored by the Scottish Bacterial Sexually Transmitted Reference Laboratory (SBSTIRL). The latest data available indicate that in 2016, 42% of all episodes of gonorrhoea tested were resistant to one or more antibiotics. This is similar to that reported in the previous four years (see surveillance report at http://www.hps.scot.nhs.uk/ewr/redirect.aspx?id=70499). There were no isolates with decreased susceptibility to ceftriaxone, one of the front line drugs for treatment recommended in the UK and by WHO. However, of note is the decreased susceptibility to azithromycin, used in combination with ceftriaxone, in 5% of isolates. These isolates remain sensitive to ceftriaxone and thus, individuals can be treated. High level azithromycin resistance recently emerged in England, while numbers are low in Scotland to date, this is being investigated. We remain alert to any drift towards treatment failure particularly through the emergence of ceftriaxone resistance.