Journal Article

Evaluating spatially adaptive guidelines for the treatment of gonorrhea to reduce the incidence of gonococcal infection and increase the effective lifespan of antibiotics

Yaesoubi, Reza, Hsu, Katherine, St. Cyr, Sancta B., Gift, Thomas L., Salomon, Joshua A., Grad, Yonatan H., Cohen, Ted

2022

Overview

In the absence of point-of-care gonorrhea diagnostics that report antibiotic susceptibility, gonorrhea treatment is empiric and determined by standardized guidelines. These guidelines are informed by estimates of resistance prevalence from national surveillance systems. We examined whether guidelines informed by local, rather than national, surveillance data could reduce the incidence of gonorrhea and increase the effective lifespan of antibiotics used in treatment guidelines. We used a transmission dynamic model of gonorrhea among men who have sex with men (MSM) in 16 U.S. metropolitan areas to determine whether spatially adaptive treatment guidelines based on local estimates of resistance prevalence can extend the effective lifespan of hypothetical antibiotics. The rate of gonorrhea cases in these metropolitan areas was 5,548 cases per 100,000 MSM in 2017. Under the current strategy of updating the treatment guideline when the prevalence of resistance exceeds 5%, we showed that spatially adaptive guidelines could reduce the annual rate of gonorrhea cases by 200 cases (95% uncertainty interval: 169, 232) per 100,000 MSM population while extending the use of a first-line antibiotic by 0.75 (0.55, 0.95) years. One potential strategy to reduce the incidence of gonorrhea while extending the effective lifespan of antibiotics is to inform treatment guidelines based on local, rather than national, resistance prevalence.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Anti-Bacterial Agents - therapeutic use / Antibiotics / Antimicrobial agents / Asymptomatic / Biology and Life Sciences / Care and treatment / Confidence intervals / Control / Distribution / Dosage and administration / Drug resistance in microorganisms / Dynamic models / Earth Sciences / Estimates / Gonorrhea / Gonorrhea - drug therapy / Gonorrhea - epidemiology / Gonorrhea - prevention & control / Guidelines / Homosexuality, Male / Humans / Incidence / Infections / Life span / Longevity / Male / Medical research / Medicine and Health Sciences / Medicine, Experimental / Metropolitan areas / Neisseria gonorrhoeae / People and Places / Practice guidelines (Medicine) / Sexual and Gender Minorities / Sexually transmitted diseases / Social Sciences / STD / Surveillance / Surveillance systems / Trends