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    WHO warns that gonorrhoea is becoming incurable once again

    According to an announcement by the World Health Organization(WHO) on 6 July, data collected from 77 countries show that antibiotic resistance is making gonorrhoea – a common sexually-transmitted infection – much harder, and sometimes impossible, to treat. The announcement included information about a new gonorrhoea drug in development.

    Gonorrhoea was once incurable in the 1920s before the first drugs to treat it were discovered. Since the 1930s, several classes of antibiotics have been used to kill the bacterium that causes gonorrhoea, Neisseria gonorrhoeae. Widespread use — and misuse — of these drugs, however, has led to a rise of antibiotic-resistant strains of the bacteria. Health agencies in the United States, Europe and Canada have in recent years flagged drug-resistant gonorrhoea as an emerging threat. If left untreated, gonorrhoea can increase a woman’s risk of developing HIV infection, infertility or ectopic pregnancy — among other effects.

    WHO reports widespread resistance to older and cheaper antibiotics. Some countries – particularly high-income ones, where surveillance is best – "are finding cases of the infection that are untreatable by all known antibiotics," said the WHO statement.

    According to a paper published in PLoS Medicine1 on 7 July, there is robust resistance to three common types of antibiotics prescribed for gonorrhoea. Of the countries surveyed around the world, 97% reported cases that were resistant to ciprofloxacin, the cheapest and most widely available treatment; 81% reported gonorrhoea cases resistant to azithromycin; and 66% to cephalosporins.

    The R&D pipeline for gonorrhoea is relatively empty, with only 3 new candidate drugs in various stages of clinical development: solithromycin, for which a phase III trial has recently been completed; zoliflodacin, which has completed a phase II trial; and gepotidacin, which has also completed a phase II trial.

    The development of new antibiotics is not very attractive for commercial pharmaceutical companies. Treatments are taken only for short periods of time (unlike medicines for chronic diseases) and they become less effective as resistance develops, meaning that the supply of new drugs constantly needs to be replenished. The Drugs for Neglected Diseases initiative (DNDi) and WHO have launched the Global Antibiotic Research and Development Partnership (GARDP), a not-for-profit research and development organization, hosted by DNDi, to address this issue.

    Now, the DNDi and Entasis have announced that they will launch a phase III trial of zoliflodacin involving about 650 individuals in South Africa, the United States and Thailand, among other countries. The team expects to start in November 2018. If the drug is approved by regulators, Entasis will permit generic manufacturers to sell the drug in most low- and middle-income nations. Entasis will retain exclusivity to the treatment in high-income countries. And the DNDi says that it will fund public-health studies to find the best means of ensuring that the drugs are not overused

    Read more:

    Wi, T. et al. PLOS Med. (2017).