Recent azithromycin use associated with resistant gonorrhea
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Recent azithromycin use was associated with an increased risk for azithromycin-resistant gonorrhea, according to a study.
The finding, published in Clinical Infectious Diseases, backs up a CDC decision in 2020 to remove the drug from its frontline treatment guidelines for gonorrhea in favor of ceftriaxone monotherapy.
“Our findings support the change to discontinue azithromycin as part of dual therapy for gonorrhea treatment,” Emily Rowlinson, PhD, MPH, a doctoral student at the University of Washington when the study was conducted, told Healio.
Rowlinson and colleagues conducted a retrospective cohort study of medical records for 2,155 patients seen at a Public Health Seattle-King County sexual clinic from 2012 to 2019. The participants had 2,828 gonorrhea infections — roughly 6% of which were azithromycin resistant.
Of 156 patients with a drug-resistant gonorrhea, 2.6% had received a prescription for azithromycin in the previous 29 days and 24% had received one in the previous 30 to 364 days.
Although azithromycin use in the previous 30 to 364 days was not associated with azithromycin-resistant gonorrhea, use in the previous 29 days was strongly associated with resistance (adjusted OR = 6.76; 95% CI, 1.76-25.9) after adjusting for clinical, demographic and risk behavior characteristics, Rowlinson and colleagues reported.
They said the relationship persisted when they restricted their analysis to extragenital infections, and that although the association between receiving azithromycin and having azithromycin-resistant gonorrhea among patients with a penile urethral infection was not statistically significant, “the similar effect size for this estimate along with wide confidence bounds may indicate we did not have sufficient statistical power to detect such an association if it exists.”
“Over the years, gonorrhea has become resistant to nearly every class of antimicrobial, except ceftriaxone, the only remaining highly effective antimicrobial to treat gonorrhea in the United States,” Kim Workowski, MD, a medical officer in CDC’s Division of STD Prevention, told Healio.
The purpose of the dual therapy treatment, Workowski said, was an attempt at preserving the efficacy of ceftriaxone “for as long as possible and until new antimicrobials are available.”
Previous studies have shown an association between azithromycin exposure and increased levels of resistance to the drug, which may be what has helped contribute to increased circulation of drug-resistant gonorrhea, Rowlinson said.
The recent study did not consider the potential of acquiring drug-resistant gonorrhea because of azithromycin use for other indications. Although Rowlinson said it is plausible that non-STD treatment use could increase this risk, she said she is not aware of evidence that shows this increased risk.
“This potential underlines the importance of following current STD treatment guidelines and using ceftriaxone monotherapy to treat persons with confirmed or suspected gonorrhea infections, or as part of epidemiologic treatment for persons exposed to a sexual partner with gonorrhea infection,” Rowlinson said.
References:
- Rowlinson E, et al. Clin Infect Dis. 2022;doi:10.1093/cid/ciac682.
- St. Cyr S, et al. MMWR Morb Mortal Wkly Rep. 2020;doi:10.15585/mmwr.mm6950a6.
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