Dual Azithromycin/Ceftriaxone Therapy for Gonorrhea in PrEP Cohorts Results in Levels of Macrolide Consumption That Exceed Resistance Thresholds by up to 7-Fold
Chris Kenyon
Abstract
To the Editor—Banhart et al recently described an alarming increase in gonococcal azithromycin resistance in Germany [1]. A plausible explanation for this increase is excessive macrolide consumption, particularly in core groups with a high prevalence of gonorrhea, such as preexposure prophylaxis (PrEP) cohorts [2, 3]. Banhart et al noted that dual therapy for gonorrhea (azithromycin/ceftriaxone) as advocated by the European International Union against Sexually Transmitted Infections (IUSTI) guidelines [4] is one possible source of selection pressure for macrolide resistance. To test this hypothesis, we estimated macrolide consumption related to 2 gonorrhea treatment protocols in a well characterized PrEP cohort at our center: (1) dual therapy with ceftriaxone 1 g intramuscular injection (IMI) and azithromycin 2 g per os (PO) single dose (European IUSTI guidelines [4]); and (2) monotherapy with ceftriaxone 1 g IMI (US Centers for Disease Control and Prevention...