{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T13:39:37Z","timestamp":1762868377182,"version":"3.37.3"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,1,20]],"date-time":"2021-01-20T00:00:00Z","timestamp":1611100800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/open-government-licence\/version\/3\/"}],"funder":[{"DOI":"10.13039\/501100002141","name":"Public Health England","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002141","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Neisseria gonorrhoeae has developed resistance to all antimicrobials used to treat gonorrhoea, with even ceftriaxone being undermined. It is therefore important to examine any potential to redeploy older antimicrobials routinely used for other infections to treat ceftriaxone-resistant gonococcal infections.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We examined the susceptibility of N. gonorrhoeae to aztreonam, chloramphenicol, co-trimoxazole, fosfomycin, piperacillin\/tazobactam and rifampicin.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>N. gonorrhoeae isolates (n\u2009=\u200994) were selected to include a range of antimicrobial susceptibilities: 58 were collected in the Gonococcal Resistance to Antimicrobials Surveillance Programme; 17 were clinical isolates referred to the PHE reference laboratory; and 19 were control strains. MICs were determined by agar dilution for the six study antimicrobials and for ceftriaxone and azithromycin as comparators.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There was correlation between piperacillin\/tazobactam and ceftriaxone MICs, but all five isolates with high ceftriaxone MICs (&amp;gt;0.5\u2009mg\/L) were inhibited by piperacillin\/tazobactam at 0.06\u20130.5\u2009mg\/L. Aztreonam MICs for ceftriaxone-resistant isolates exceeded those of ceftriaxone. Among non-\u03b2-lactams, fosfomycin and co-trimoxazole had low, tightly clustered MICs, suggesting widespread susceptibility, rifampicin split the collection into highly susceptible and highly resistant groups and chloramphenicol had a wide MIC distribution.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Although unsuitable for empirical use, piperacillin\/tazobactam, fosfomycin, co-trimoxazole, rifampicin and, possibly, chloramphenicol could be considered for individual patients with ceftriaxone-resistant gonococcal infection once MICs are known. Wider surveillance of the susceptibility of N. gonorrhoeae to these agents is needed, along with clinical trials and the establishment of clinical breakpoints for N gonorrhoeae.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkaa559","type":"journal-article","created":{"date-parts":[[2020,12,31]],"date-time":"2020-12-31T20:20:56Z","timestamp":1609446056000},"page":"1215-1220","source":"Crossref","is-referenced-by-count":11,"title":["What\u2019s left in the cupboard? Older antimicrobials for treating gonorrhoea"],"prefix":"10.1093","volume":"76","author":[{"given":"Helen","family":"Fifer","sequence":"first","affiliation":[{"name":"National Infection Service, Public Health England, London NW9 5EQ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David M","family":"Livermore","sequence":"additional","affiliation":[{"name":"Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thinushaa","family":"Uthayakumaran","sequence":"additional","affiliation":[{"name":"National Infection Service, Public Health England, London NW9 5EQ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Woodford","sequence":"additional","affiliation":[{"name":"National Infection Service, Public Health England, London NW9 5EQ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6707-6910","authenticated-orcid":false,"given":"Michelle J","family":"Cole","sequence":"additional","affiliation":[{"name":"National Infection Service, Public Health England, London NW9 5EQ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,1,20]]},"reference":[{"key":"2021041608541161600_dkaa559-B1","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1128\/CMR.00010-14","article-title":"Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future","volume":"27","author":"Unemo","year":"2014","journal-title":"Clin Microbiol Rev"},{"key":"2021041608541161600_dkaa559-B2","doi-asserted-by":"crossref","first-page":"735","DOI":"10.3201\/eid2404.171873","article-title":"Cooperative recognition of internationally disseminated ceftriaxone-resistant Neisseria gonorrhoeae strain","volume":"24","author":"Lahra","year":"2018","journal-title":"Emerg Infect Dis"},{"key":"2021041608541161600_dkaa559-B3","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2019.24.8.1900118","article-title":"Genetic relatedness of ceftriaxone-resistant and high-level azithromycin resistant Neisseria gonorrhoeae cases, United Kingdom and Australia, February to April 2018","volume":"24","author":"Jennison","year":"2019","journal-title":"Euro Surveill"},{"key":"2021041608541161600_dkaa559-B4","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2018.23.27.1800323","article-title":"Gonorrhoea treatment failure caused by a Neisseria gonorrhoeae strain with combined ceftriaxone and high-level azithromycin resistance, England, February 2018","volume":"23","author":"Eyre","year":"2018","journal-title":"Euro Surveill"},{"key":"2021041608541161600_dkaa559-B5","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2019.24.10.1900147","article-title":"Detection in the United Kingdom of the Neisseria gonorrhoeae FC428 clone, with ceftriaxone resistance and intermediate resistance to azithromycin, October to December 2018","volume":"24","author":"Eyre","year":"2019","journal-title":"Euro Surveill"},{"year":"2018","key":"2021041608541161600_dkaa559-B6"},{"key":"2021041608541161600_dkaa559-B7","doi-asserted-by":"crossref","first-page":"2511","DOI":"10.1016\/S0140-6736(18)32817-4","article-title":"Gentamicin compared with ceftriaxone for the treatment of gonorrhoea (G-ToG): a randomised non-inferiority trial","volume":"393","author":"Ross","year":"2019","journal-title":"Lancet"},{"key":"2021041608541161600_dkaa559-B8"},{"key":"2021041608541161600_dkaa559-B9","doi-asserted-by":"crossref","first-page":"3096","DOI":"10.1093\/jac\/dkw288","article-title":"The novel 2016 WHO Neisseria gonorrhoeae reference strains for global quality assurance of laboratory investigations: phenotypic, genetic and reference genome characterization","volume":"71","author":"Unemo","year":"2016","journal-title":"J Antimicrob Chemother"},{"key":"2021041608541161600_dkaa559-B10","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1071\/SH16162","article-title":"Prevalence of porA pseudogene deletion among Neisseria gonorrhoeae isolates referred to the UK's Gonococcal Resistance to Antimicrobials Surveillance Program","volume":"14","author":"Toby","year":"2017","journal-title":"Sex Health"},{"year":"2018","key":"2021041608541161600_dkaa559-B11"},{"key":"2021041608541161600_dkaa559-B12","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.1093\/jac\/dkt537","article-title":"Evaluation of the activity of ertapenem against gonococcal isolates exhibiting a range of susceptibilities to cefixime","volume":"69","author":"Quaye","year":"2014","journal-title":"J Antimicrob 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