New Antibiotic to Treat Gonorrhea

[Luv2play]

I read today a promising new antibiotic to treat gonorrhea has been announced by a multi country consortium. It is a new class of antibiotics that are promising to avoid the growing drug resistance of existing treatments.

The name of the drug is Zoliflodacin and hasn't been licensed for sale yet. But plans are to market it in 160 low income countries at low cost and market rates in higher income countries. 

The test group of some 900 plus  individuals were mostly treated for genital gonorrhea and not throat or rectum so results are mostly skewed to heterosexual contacts. But scientists involved said the treatment with this new class of drugs was likely to work just as well in those cases.

The new drug is as effective as the most powerful treatment currently available which is using two different antibiotics together. And apparently this new drug is pointing the way to other new drugs for different conditions. 

It's being hailed as a breakthrough in the field of antibiotics.

[+ nycman]

Don’t get too excited……

"N. gonorrhoeae can evolve resistance to zoliflodacin in the laboratory."

https://www.nature.com/articles/d41586-023-03448-x

And it’s not exactly a “new drug"….this is from 2018:

"but this agent was less efficacious in the treatment of pharyngeal infections."

 https://www.nejm.org/doi/full/10.1056/NEJMoa1706988

Good news indeed, but I’m afraid it won’t last long. N. gonorrhea Is an amazing bacteria.

[Guest]

@purplekow What are your thoughts doc? Please and thank you 🙏🏽 

Edited November 11, 2023 by Vin_Marco

[SirBillybob]

Right, the mid20teens Phase 2 study results provide clues to the Phase 3 results media release emphasis on zoliflodacin’s noninferior urogenital infection cure rate. All subjects had urogenital infection as it was the inclusion criterion. As in Phase 2, the recent trial cure rates for simultaneous pharyngeal or rectal infection were evaluated and compared to standard treatment. If noninferiority criteria had been met for either of those secondary outcome infection sites, albeit sufficiently statistically powered (unlike Phase 2), I assume it would have been enthusiastically mentioned.

On top of that, there is the high cure rate requirement gold standard of 95% which was probably not satisfied for pharyngeal infection treatment with zoliflodacin if consistent with Phase 2 trends, even though Phase 3 dosing was the more effective higher dose of Phase 2 dose escalation. 

We will have to wait for the data to be peer reviewed but it appears to be more promising for Adam & Eve than for Adam & Yves. The former also benefit from the more overt symptom presentation of urethral and cervical gonorrhea whereas pharyngeal and rectal infection is usually detected, latently if at all, via routine screening.

Edited November 11, 2023 by SirBillybob

[+ purplekow]

While resistant gonorrhea is going to become a larger and larger problem, at this time, the routine treatment for gonorrhea is cheap and effective in most cases in most places.  There are pockets of areas where there is a larger percentage of resistant strain gonorrhea and in those areas a drug which is effective against the resistant bacteria is beneficial.  While the article states that eventually the treatment cost will be as inexpensive as treatment for GC is now, that will occur only after the developing company has lost its patent, at least that will be the case in the US.  So given the likely high initial cost, the possibility of resistance to this drug developing from overuse and the relative effectiveness of the present treatment, this advance initially only will make a small difference in the manner in which GC will be treated,    Prevention is still the best course of action.  Public health efforts such as legalization of sex work and required testing for sex workers in order to locate and treat unsuspected cases of the disease would also slow the development of a more resistant GC dominant strain.  But the bacteria always win these races.  Encouragement of use of condoms,( I know I know I know no one wants to hear that) is another potential brake on the eventual collision of humans and super resistant GC.  

Edited November 11, 2023 by purplekow

[+ purplekow]

4 minutes ago, purplekow said:

While resistant gonorrhea is going to become a larger and larger problem, at this time, the routine treatment for gonorrhea is cheap and effective in most cases in most places.  There are pockets of areas where there is a larger percentage of resistant strain gonorrhea and in those areas a drug which is effective against the resistant bacteria is beneficial.  While the article states that eventually the treatment cost will be as inexpensive as treatment for GC is now, that will occur only after the developing company has lost its patent, at least that will be the case in the US.  So given the likely high initial cost, the possibility of resistance to this drug developing from overuse and the relative effectiveness of the present treatment, this advance initially only will make a small difference in the manner in which GC will be treated,    Prevention is still the best course of action.  Public health efforts such as legalization of sex work and required testing for sex workers in order to locate and treat unsuspected cases of the disease would also slow the development of a more resistant GC dominant strain.  But the bacteria always win these races.  Encouragement of use of condoms,( I know I know I know no one wants to hear that) is another potential brake on the eventual collision of humans and super resistant GC.  

Just another point, antibiotic development is not particularly profitable for drug companies.  As opposed to daily medications such as statins or blood pressure medication, antibiotics are taken as needed and as such sales are many times higher in the daily drugs.  In order for medicine to keep up with mutations which lead to drug resistance, companies are going to have to have a financial incentive to increase research in this field.  

[pubic_assistance]

2 hours ago, purplekow said:

Encouragement of use of condoms,( I know I know I know no one wants to hear that) is another potential brake on the eventual collision of humans and super resistant GC.  

Everyone is in denial.

I heard they were still fucking at dungeons and bath houses in the middle of the AIDS epidemic until the Government shut them down.

Gay men, too frequently, think with their dick.

[Bokomaru]

4 hours ago, purplekow said:

In order for medicine to keep up with mutations which lead to drug resistance, companies are going to have to have a financial incentive to increase research in this field.  

Agreed. That leads us to the main point of this recent news. Not that there’s a new antibiotic, but that there’s a new model for antibiotic development. The development wasn’t funded by a single, for-profit pharmaceutical company. From the NYTimes:

”Pharmaceutical companies have largely abandoned antibiotic development as unprofitable. The development of zoliflodacin represents a new model: G.A.R.D.P., which is funded by many Group of 20 countries and the European Union, developed the drug in collaboration with an American pharmaceutical company called Innoviva Specialty Therapeutics.”

Edited November 11, 2023 by Bokomaru
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