title: Stemming the tide of drug-resistant Neisseria gonorrhoeae: the need for an individualized approach to treatment.
abstract: Drug-resistant Neisseria gonorrhoeae poses a significant public health challenge. In recent years, gonococci resistant to first- and second-line antibiotics have spread worldwide and new strains have developed that are increasingly resistant to third-generation cephalosporins, which are currently our last line of available treatments. Given the timeline required to develop new drugs or an effective vaccine for N. gonorrhoeae, a top priority is to use the drugs that are available as effectively as possible. Currently, clinical management of gonorrhoea is based upon treatment guidelines informed by international gonococcal antimicrobial susceptibility surveillance programmes. This approach, although currently the most practical, is subject to a number of limitations since surveillance data inherently provide population-level information. As a result, basing treatment guidelines on these data can result in the prescription of more aggressive or broader treatment than is needed by individual patients and hence inadvertently contribute to the development and spread of resistance to important drugs. Clearly, methods are needed that provide patient-specific drug susceptibility information in a time frame that would allow clinicians to prescribe individualized treatment regimens for gonorrhoea. Fortunately, in recent years, there have been a number of advances in the development of rapid methods for characterizing both the genotype and the drug resistance phenotype of N. gonorrhoeae strains. Here, we review these advances and propose additional studies that would help facilitate a transition towards an individualized treatment approach for gonorrhoea.
authors.affiliation: Department of Environmental Health Sciences, Fielding School of Public Health, UCLA, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA UCLA Global Bio Lab, California Nanosystems Institute, UCLA, 570 Westwood Plaza Building 114, Los Angeles, CA 90095, USA sbuono@ucla.edu.
authors.forename: Sean A
authors.initials: SA
authors.lastname: Buono
authors.affiliation: Department of Environmental Health Sciences, Fielding School of Public Health, UCLA, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA.
authors.forename: Tyler D
authors.initials: TD
authors.lastname: Watson
authors.affiliation: UCLA Global Bio Lab, California Nanosystems Institute, UCLA, 570 Westwood Plaza Building 114, Los Angeles, CA 90095, USA Los Angeles County Public Health Laboratory, 12750 Erickson Avenue, Downey, CA 90242, USA.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Borenstein
authors.affiliation: David Geffen School of Medicine, UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
authors.affiliation: San Francisco Public Health Laboratory, San Francisco Department of Public Health, 101 Grove Street, Suite 419, San Francisco, CA 94102, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Pandori
authors.affiliation: Department of Environmental Health Sciences, Fielding School of Public Health, UCLA, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA UCLA Global Bio Lab, California Nanosystems Institute, UCLA, 570 Westwood Plaza Building 114, Los Angeles, CA 90095, USA Institute of the Environment and Sustainability, UCLA, La Kretz Hall, Suite 300, Box 951496, Los Angeles, CA 90095, USA.
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Godwin
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D006069:Gonorrhea / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000235:genetics; D021141:Nucleic Acid Amplification Techniques / Q000379:methods; D057285:Precision Medicine; D015995:Prevalence
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic resistance; antimicrobial susceptibility testing; combination therapy; gonorrhoea; guidelines; molecular surveillance; nucleic acid amplification tests; public health