Prior Azithromycin therapy associated with reduced susceptibility of gonococcal infections to drug

USA: Subsequent azithromycin reduced susceptibility (AZMRS) gonococcal infections are linked to recent individual-level AZM therapy, says an article published in Clinical Infectious Diseases.

There is contradictory information regarding whether earlier exposure to azithromycin (AZM) reduces a person's sensitivity to it when they have Neisseria gonorrhoeae infection (NG). Emily Rowlinson and colleagues conducted this investigation in order to determine if prior azithromycin exposure has any impact on AZM decreased susceptibility.

The research sample comprised individuals from the Public Health-Seattle & King County Sexual Health Clinic (SHC) with culture-positive NG infection at one anatomic location whose isolates were screened for AZM susceptibility from 2012 to 2019.

Multivariate logistic regression was used to examine the relationship between the time since the last AZM prescription from the SHC in 12 months and subsequent diagnosis with AZMRS NG (minimum inhibitory concentration [MIC] ≥2.0 g/ml), and linear regression was used to assess the relationship between the number of AZM prescriptions in 12 months and AZM MIC level while controlling for demographic, behavioral, and clinical characteristics.

The key findings of this study were:

1. AZMRS NG was substantially related to receipt of AZM from the SHC in the preceding 29 days, but not with receipt of AZM in the prior 30-365 days, in a total of 2,155 unique patients with 2,828 incident NG infections, 156 (6%) of which were caused by AZMRS NG.

2. The log AZM MIC level was not related to the number of AZM prescriptions written within 12 months, however, it was related to the number of prescriptions written within 30 days.

In conclusion, this possibility emphasizes the significance of adhering to existing STD treatment recommendations and employing ceftriaxone monotherapy to treat people with confirmed or suspected gonorrhea infections, or as part of epidemiologic treatment for those who have had sexual contact with someone who has gonorrhea.

Reference: 

Rowlinson, E., Soge, O. O., Hughes, J. P., Berzkalns, A., Thibault, C., Kerani, R. P., Khosropour, C. M., Manhart, L. E., Golden, M. R., & Barbee, L. A. (2022). Prior exposure to azithromycin and azithromycin resistance among persons diagnosed with Neisseria gonorrhoeae infection at a Sexual Health Clinic 2012-2019. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, ciac682. https://doi.org/10.1093/cid/ciac682