Resistance Guided Therapy

“Antimicrobial Resistance (AMR), another cross-border slow moving tsunami. Early warnings have been issued on AMR and its impact. We must act.”

Dr Margaret Chan Director General of the World Health Organization

Resistance Guided Therapy

Tackling AMR with diagnostics that detect genetic markers for resistance

Antibiotic resistance in sexually transmitted infections (STIs) is a growing public health issue. STIs have the potential to become the first incurable bacterial infections since the introduction of antibiotics.1
Diagnostic tests that detect bacterial infection and genetic markers for antibiotic resistance in a single test can address this looming issue by enabling resistance guided therapy.
The benefits of resistance guided therapy include:

  • patients receiving the correct treatment
  • expedited notification of sexual partner(s)
  • reduced healthcare costs
  • halting the spread of antibiotic resistant infections
  • maintaining the efficacy of antibiotic treatment (antibiotic stewardship)
“Today, antibiotics are rarely prescribed based on a definitive diagnosis. Diagnostic tests can show whether or not an antibiotic is actually needed, and which one. Having rapid, low-cost, and readily available diagnostics is an essential part of the solution to this urgent problem.”

– Dr Margaret Chan, Director General of the World Health Organization2

Mycoplasma genitalium has emerged as a sexually transmitted infection with prevalence rates higher than gonorrhoea in many populations.3 Like gonorrhoea, this bacterium has developed a high frequency of resistance to frontline antibiotic treatment, and for resistance strains, we have limited treatment options.3 This situation necessitates rapid resistance assays which will enable secondary treatment options to be used sparingly. To this point, emerging resistance to secondary treatment options such as fluoroquinolones have already been reported.4 The time to act is now!

“Although antimicrobial resistance is a massive challenge, it is one that I believe is well within our ability to tackle effectively. The human and economic costs compel us to act: if we fail to do so, the brunt of these will be borne by our children and grandchildren, and felt most keenly in the poorest parts of the world.”

– Lord Jim O’Neill2

The misuse and overuse of antibiotics has led to concerning levels of global resistance rates, resulting in a world-wide call to action.2 In diseases such as TB, the implementation of resistance-guided therapy is now common practice.5 It is well recognized that disease causing bacteria such as Mycoplasma genitalium (MG) are on the path to becoming “super-bugs”.1 There is an urgent need for new strategies and treatments to manage STDs rather than relying on a traditional syndromic approach. Availability of molecular resistance testing introduces resistance-guided therapy to STD management.

Changing the way STIs are treated

jorgen-article

Dr Jorgen Skov Jensen

Consultant physician in microbiology & infection control,
Statens Serum Institut, Denmark | View full article at Media Planet

References

1. Unemo, M. & Jensen, J.S. Antimicrobial-resistant sexually transmitted infections: gonorrhoea and Mycoplasma genitalium. 2016. Nat. Rev. Urol..268. Published online 10 Jan 2017. doi:10.1038/nrurol
2.O’Neill J. Tackling drug-resistant infections globally: final report and recommendations. The Review on Antimicrobial Resistance. May 2016:35.
3.Oakeshott P, Aghaizu A, Hay P, et al. Is Mycoplasma genitalium in women the “new chlamydia”? a community‐based prospective cohort study. Clin Infect Dis. 2010;51(10):1160–1166.
4.Tagg KA, Jeoffreys NJ, Couldwell DL., Donald JA, Gilbert GL. Fluoroquinolone and macrolide resistance-associated mutations in Mycoplasma genitalium. J Clin Microbiol. 2013;51(7):2245–2249.
5.World Health Organization. WHO treatment guidelines for drug-resistant tuberculosis, 2016 update. Geneva, Switzerland: World Health Organization; 2016.

Antimicrobial-resistant Neisseria gonorrhoeae is a serious public health threat and reports have been emerging of strains that are resistant to all known treatments.1 While new treatments are still in development, urgent action is needed to improve management strategies to control gonorrhoea, including improved diagnostics and better utilization of existing drugs. Traditional syndromic management of STDs requires >95% efficacy, however the availability of molecular tests which can diagnose infection and detect resistance markers will enable older treatments to be ‘recycled’ into use. Approximately 80% of N. gonorrhoeae infections in the US are susceptible to ciprofloxacin, and studies have shown that the gyrA genotype has >98% sensitivity and specificity to predict ciprofloxacin susceptibility.2,3

Tackling Drug-Resistant Infections Globally – 2016

gonorrhoea case study

Full Case Study
All credits towards AMR review and Lord Jim O’Neill

References

1.Terkelsen D., Tolstrup J., Johnsen C.H. et al. Multidrug-resistant Neisseria gonorrhoeae infection with ceftriaxone resistance and intermediate resistance to azithromycin, Denmark, 2017. Euro Surveill. 2017 Oct;22(42).
2.Trembizki E., Guy R., Donovan B., Kaldor J.M., Lahra M.M., Whiley D.M. Further evidence to support the individualised treatment of gonorrhoea with ciprofloxacin.Lancet Infect Dis. 2016 Sep;16(9):1005-1006.
3.Allan-Blitz LT1, Wang X, Klausner JD. Wild-Type Gyrase A Genotype of Neisseria gonorrhoeae Predicts In Vitro Susceptibility to Ciprofloxacin: A Systematic Review of the Literature and Meta-Analysis. Sex Transm Dis. 2017 May;44(5):261-265.

Dr. Catriona Bradshaw
Melbourne Sexual Health

M.genitalium management in the era of escalating antimicrobial resistance.

Click here for exclusive access to Dr. Bradshaw’s IUSTI presentation outlining her work with Mycoplasma genitalium and resistance guided therapy.

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