Could we optimise testing for gonorrhoea to avoid the use of last-line antibiotics?

Ceftriaxone is the first-line treatment for gonorrhoea but there are few alternative treatments available should ceftriaxone resistance become widespread. Aquarius created a model to explore how point-of-care testing could be used to diagnose gonorrhoea and at the same time test for antibiotic susceptibility, which could allow the use of previously abandoned antibiotics for many patients, thereby sparing ceftriaxone use.

Antimicrobial resistance (AMR) has developed to every class of antibiotic used for the treatment of gonorrhoea and in recent years, a number of multi-drug resistant strains of gonorrhoea have been reported in the UK and elsewhere. Once the prevalence of resistance to a first-line treatment reaches 5%, a different drug is selected as first-line treatment. However, there is not another treatment option if resistance develops to ceftriaxone. Therefore, steps are being taken to preserve the effectiveness of this drug by considering ways of using previously abandoned drugs for infections which are susceptible. We created a health economic model to compare the cost and effectiveness of five different strategies which could be used to test for susceptibility in patients diagnosed with gonorrhoea.

The results of the model showed that all the potential testing strategies would cost more than the current strategy of no AMR testing. The paper concludes that AMR point-of-care testing may enable improved antibiotic stewardship but would require investment into the health system.

This work was commissioned by the Applied Diagnostic Research and Evaluation Unit (ADREU) at St. George’s, University of London and was published this week in Eurosurveillance (Open Access).

This is one of many cost-effectiveness analyses we have developed for diagnostic companies, government bodies and healthcare providers in the UK and internationally. If you are interested in finding out more about Aquarius and the evidence generation we provide, please email info@aquariusph.com.