To What Extent Should We Rely on Antibiotics to Reduce High Gonococcal Prevalence? Historical Insights from Mass-Meningococcal Campaigns.

Chris Kenyon

doi:10.3390/pathogens9020134

Abstract

In the absence of a vaccine, current antibiotic-dependent efforts to reduce the prevalence of Neisseria gonorrhoeae in high prevalence populations have been shown to result in extremely high levels of antibiotic consumption. No randomized controlled trials have been conducted to validate this strategy and an important concern of this approach is that it may induce antimicrobial resistance. To contribute to this debate, we assessed if mass treatment in the related species, Neisseria meningitidis, was associated with the emergence of antimicrobial resistance. To this end, we conducted a historical review of the effect of mass meningococcal treatment programmes on the prevalence of N. meningitidis and the emergence of antimicrobial resistance. We found evidence that mass treatment programmes were associated with the emergence of antimicrobial resistance.

Highlights

The World Health Organization’s plan to reduce the incidence of Neisseria (N.) gonorrhoeae by90% by 2030 faces two growing challenges—antimicrobial resistance and rising rather than falling incidence of N. gonorrhoeae in many key populations [1,2]
A concern of such high levels of antibiotic consumption is the induction of antimicrobial resistance (AMR) in N. gonorrhoeae and other organisms [4]
This study found a temporal association between mass treatment and the emergence of gonococcal AMR, its contemporary relevance is reduced by the fact that it was conducted using penicillin in the 1960s [8,9]

Summary

Introduction

The World Health Organization’s plan to reduce the incidence of Neisseria (N.) gonorrhoeae by. These studies have typically found that mass treatment has no effect [5,6,7], or only a temporary effect on gonorrhoea incidence/prevalence [8,9] One of these studies evaluated the effect on AMR. These considerations suggest that if mass treatment of N. meningitidis is associated with the emergence of AMR, this would provide a cautionary warning for using antibiotic based strategies to reduce the prevalence of N. gonorrhoeae in high prevalence settings such as PrEP cohorts. A recent review paper by MacNamara et al evaluated the effect of mass treatment of N. meningitidis on the prevalence of the bacteria and the emergence of AMR in over 33 studies [10]. No studies evaluated the emergence of resistance to other antimicrobials such as ceftriaxone and azithromycin

Individual Level Assessment

Findings

Discussion