Silver lining in rising MDR-N. gonorrhoeae?

We've written about poor funding for MDR-bacterial prevention studies and antimicrobial discovery. In fact, our NIH funding paper with Dan Kwon and Marin Schweizer looking at NIAID support for ESCKAPE-pathogen studies was just published in ARIC. It's a major problem, as there has been almost no governmental or private funding for antibacterial discovery in decades. Don't even get me started on funding for infection prevention studies. Only 4 good studies on hand-hygiene improvement since the 1950's, seriously?

With that background, I read with interest Gail Bolan's (CDC) editorial in this past week's NEJM.  In it she sounds the alarm for resistance in gonococcus based on a recent 17-fold rise in 3rd-generation cephalosporin resistance (cefixime) from 0.1% to 1.7% with higher rates in Western states. (See graph above) This rise in cephalosporin resistance follows sulfa resistance in the 1940s, PCN and TCN resistance in the 1980s, and fluoroquinolone resistance by 2007.

An interesting fact shared in the article is that when resistance to a particular drug class reaches 5%, the CDC's Gonococcal Isolate Surveillance Project(GISP) changes treatment recommendations to a new class of antibiotics. Sadly, only third-generation cephalosporins are left. I wonder if this class switch at 5% is contributing to the rise in resistance?  That question will remain unanswered - no funding. Also, imagine having a 5% threshold in hospitalized patients.  We would have run out of choices years ago!

So what is the silver lining in all of this?  I have a suspicion that politicians and others might be motivated by an STD with an annual incidence of 600,000 in the US. I'm not saying that politicians are at higher risk for STDs, no judging, but STDs put many people at risk, so there will be pressure to respond to this.  The silver lining is that antibacterials designed or discovered that are effective in treating GC will likely have efficacy for other MDR-bacteria, such as Acinetobacter. 

Thus, when Bolan and colleagues suggest that "the immediate priority is replenishing the drug pipeline to treat gonococcal infections," I have hope that people will listen.  There are few grassroots organizations fighting for antibiotic discovery, but there may be soon.  I hope so; our hospitalized patients are counting on it.


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