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Warning of a looming public health crisis, the Infectious Diseases Society of America (IDSA) is calling for new antibiotics to treat gonorrhea, a common drug-resistant "superbug" that has become increasingly difficult to treat.
IDSA's plea came in response to an announcement by the Centers for Disease Control and Prevention (CDC) that gonorrhea resistance to powerful antibiotics known as fluoroquinolones has become widespread throughout the country. This development means that only one class of antibioticscephalosporinscan be used to treat gonorrhea. CDC's data and treatment recommendations will be published in the April 13 issue of Morbidity and Mortality Weekly Report (MMWR).
"Gonorrhea has now joined the list of other superbugs for which treatment options have become dangerously few," said Henry Masur, MD, president of IDSA. "To make a bad problem even worse, we're also seeing a decline in the development of new antibiotics to treat these infections."
Gonorrhea is the second most commonly reported infectious disease in the United States. CDC estimates that more than 700,000 Americans are infected with gonorrhea each year. Any sexually active person can become infected, and because many people do not have obvious symptoms, they can unknowingly spread the infection to others. The highest reported rates of infection in the U.S. are among sexually active teenagers, young adults, and African Americans.
Because it's so inflammatory, having gonorrhea puts people at greater risk of contracting HIV, the virus that causes AIDS, and HIV-infected people with gonorrhea are more likely to transmit HIV to someone else. In women, gonorrhea can cause pelvic inflammatory disease and ectopic pregnancy. In men, gonorrhea can lead to infertility.
Gonorrhea can be prevented by using condoms consistently and correctly, and by abstaining from sexual intercourse.
"Our main strategy for controlling gonorrhea has been to find infected patients and partners and treat them early to interrupt the chain of transmission," said Gail Bolan, MD, chief of the STD Control Branch of the California Department of Health Services and a member of IDSA's public health committee. "But this has meant relying on inexpensive drugs which are easy to administer. Now we're down to one class of drugs. That is a very perilous situation to be in. If a patient is allergic to cephalosporins (the one remaining class), we don't have a lot of options."
In recent years, drug-resistant strains of gonorrhea have become more common. This problem isn't unique to gonorrhea. All types of bacteria quickly mutate and may produce as many as 500,000 generations during one human generation. In order to survive, these bacteria develop resistance to antibiotics.
Other infections that are becoming difficult to treat because of drug resistance include methicillin-resistant Staphylococcus aureus (MRSA), a life-threatening infection that has become increasingly common among young children; Acinetobacter baumannii, a growing cause of hospital-acquired pneumonia and drug-resistant infections among soldiers returning from Iraq and Afghanistan; and vancomycin-resistant Enterococcus faecium (VRE), a major cause of bloodstream infections, infections of the heart, meningitis, and intra-abdominal infections.
"I have lost patients because the drugs that worked against these superbugs 10 years ago do not work today," said Masur. "Sadly, virtually every infectious disease doctor I know has experienced similar tragedies."
Many pharmaceutical companies are abandoning or scaling back antibiotic research and development in favor of more profitable drugs that treat chronic conditions. "It's regrettable but understandable," Masur said. Because antibiotics work so well and so fast, in most cases, they are prescribed for only one or two weeks. That means they don't have as large a market as drugs for chronic conditions, which patients may take for life. The development of resistant strains of bacteria also limits the long-term market potential for an antibiotic. Infectious diseases experts often suggest restrictions on the use of new antibiotics in order to preserve their effectiveness for those patients who need them mosta sound strategy from a public health perspective, but one that limits the market for these drugs.
"Unless we develop more incentives for drug development, we will soon return to the pre-antibiotic era, when acquiring a bacterial infection was often a death sentence," said Masur.
IDSA is urging the U.S. Congress to address this public health crisis. The Food and Drug Administration Revitalization Act being considered by a Senate committee next week provides an opportunity to expand existing incentives for so-called orphan drugs and specifically target antibiotics, which otherwise the market would not support.