Drug-Resistant Gonorrhea: The Search for New Antibiotics to Fight an Emerging Problem

by Robert Buckheit III

July 19, 2017

On July 7th, 2017, the World Health Organization (WHO) released data documenting the spread of antibiotic resistant gonorrhea in 77 countries. Gonorrhea is a common, sexual transmitted infection (STI) caused by the bacterium Neisseria gonorrhoea and, as described in the WHO report, "Each year, an estimated 78 million people are infected with gonorrhea. Gonorrhea can infect the genitals, rectum, and throat. Complications of gonorrhea disproportionally affect women, including pelvic inflammatory disease, ectopic pregnancy and infertility, as well as an increased risk of HIV." The report identified widespread, and significant resistance to older, less costly antibiotics. Surveillance in many countries also identified infections that were untreatable by all known antibiotics, particularly in developed countries where surveillance is more common, suggesting a significant problem with drug-resistant gonorrhea is likely present in countries where surveillance is not wide spread. In most countries, only extended-spectrum cephalosporines (cefixime or ceftriaxone) are currently effective against gonorrhea. An increased cefixime-resistance frequency resulted in the WHO updating the treatment guidelines for gonorrhea, dictating the use of combination antibiotics. Alarmingly, the research and development pipeline for gonorrhea is empty. According to the WHO report, there are "only 3 new candidate drugs in various stages of clinical development: solithromycin, for which a phase III clinical trial has recently been completed; zoliflodacin, which has completed a phase II clinical trial; and gepotidacin, which has also completed a phase II clinical trial." Due to a combination of lack of pharmaceutical interest, lack of profitability of antibacterial products in the pharmaceutical market, and decreased funding for product development, there is a possibility of widespread resistance to all known antibiotics on the market to treat gonorrhea.

The rise in antibacterial resistance is not unique to gonorrhea, as we have previously highlighted the threat posed by widespread antibiotic resistance. The lack of novel antibiotics in the development pipeline raises the specter of an "antibiotic-free world" reminiscent of the pre-World War II infectious disease era where a simple scratch might lead to untreatable bacterial infection and death. We applaud and are ready to support efforts by non-profit groups, academic institutions, federal funding agencies, biotechnology companies, and pharmaceutical companies to increase awareness of the growing problem and to increase funding for novel antimicrobials.

As part of our MicroSENS program, we have significant expertise with the in vitro efficacy screening for therapeutic or prevention products for microbial STIs, and the capability to screen novel compounds for activity against gonorrhea. Our targeted organism panels allow cost-effective screening against a wide range of clinically-relevant gram-positive and gram-negative organisms, including the ESKAPE pathogens, organisms causing sexually transmitted infections (gonorrhea, chlamydia, trichomonas and viral models for HSV, HIV and HPV), and anaerobic and aerobic organisms. We also have methodology to assess mechanism of action and inhibition of biofilm formation. We can quickly test novel antibiotics in customized animal models, as well as assess off target effects with our ToxiSENS in vitro toxicology program.

Contact us to learn more about ways that we can help your antibacterial development program or assist with applying for and obtaining grant funding to support the development of novel antimicrobial products.

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