Antimicrobial resistance point-of-care test for gonorrhoea

In a study commissioned by the Review on Antimicrobial Resistance, Aquarius Population Health worked with modellers at the University of Bristol to create a mathematical model. The model was used to assess the economic implications and treatment impact of introducing a hypothetical antimicrobial resistance (AMR) point-of-care test (POCT) for gonorrhoea. Results of the study were published this week in BMJ Open.

Antimicrobial resistance to gonorrhoea treatment is a growing public health concern. The prevalence of resistance among infections is carefully monitored. When the prevalence of resistance reaches 5%, a drug is no longer recommended as the standard treatment. Over time several drugs have been abandoned – including penicillin and ciprofloxacin. To prevent further resistance developing, a dual therapy of ceftriaxone and azithromycin is now the standard treatment. However,  this is also the last-line treatment. Although the level of resistance to ceftriaxone is well below the 5% threshold, there are no obvious alternative treatment if resistance develops.

It is crucial that we extend the life of ceftriaxone as novel drugs cannot be developed as quickly as resistance develops. One option is to start using the abandoned drugs to treat the infections which are susceptible to these drugs. This would preserve the use of ceftriaxone for the small number of infections with resistance to the older drugs. Assessing drug susceptibility and resistance can take several days or weeks, but POCTs, currently being developed, can rapidly assess drug susceptibility at the time of diagnosis.

The model showed that if a POCT for ciprofloxacin resistance was introduced to sexual health clinics in England, it could prevent 22,054 ceftriaxone treatments each year – a 66% reduction. A POCT for penicillin resistance would prevent 26,499 ceftriaxone treatments each year – a 79% reduction. There were additional benefits included reducing by two days the average time to patients receiving the most appropriate treatment, and avoiding any loss to follow-up. At an estimated cost of £25 per test, the total cost of introducing this type of test in England would be £34 million annually.

To read more about the study and its implications you can find the full article on the BMJ website.

This is one of several projects we have been involved in assessing the economic impact of point-of-care tests. You can find more information about our previous projects on the Case Studies page of our website.

If you would like to find out how APH can help you on a future project please get in touch.

Dr. Susie Huntington