Comparing Strategies to Introduce Two New Antibiotics for Gonorrhea: A Modeling Study
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Abstract
Introduction
Drug resistance in Neisseria gonorrhoeae is an urgent public health threat. The anticipated approval of two new antimicrobials for gonorrhea prompts the need for evidence-based rollout strategies that minimize drug resistance.
Methods
We used a stochastic compartmental model of men who have sex with men (MSM) in the United States (U.S.) to compare two main strategies—equal allocation and sequential drug deployment—for two new and one existing drug and measured the time for each drug to reach a resistance prevalence threshold of 5%. We conducted broad analyses assessing the sensitivity of our results to wide variation in parameters governing the baseline behavior of the model and drug resistance evolution and fitness.
Results
Compared to the equal allocation strategy, the sequential strategy had reached the resistance prevalence threshold i) for each drug individually in at least as many simulations; ii) for all three drugs in at least as many simulations; and iii) for at least as many drugs on average. Aber 10 years, no equal allocation strategy simulations had met the 5% resistance prevalence threshold for any of the drugs, whereas 99.6% of sequential simulations had for the first drug, of which 3.5% had also met the threshold for the second drug. The sequential strategy was worse for nearly every reasonable combination of model parameters.
Conclusion
In a model of U.S. MSM, the equal allocation strategy for introducing new drugs for gonorrhea matched or outperformed the strategy of sequential introduction in terms of resistance prevalence.
Summary
Immediately introducing two new antibiotics to treat gonorrhea alongside one currently used therapy is more effective at minimizing drug resistance than holding the new drugs in reserve.
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Strength of evidence
Reviewer(s): K Turner (University of Bristol) | 📘📘📘📘📘
M Hammerschlag (SUNY Downstate Health Sciences University) | 📒📒📒◻️◻️ -
Katy Turner
Review 1: "Comparing Strategies to Introduce Two New Antibiotics for Gonorrhea: A Modeling Study"
The reviews suggest that while the modeling provides valuable insights, further empirical data are needed before clinical translation.
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Margaret Hammerschlag
Review 2: "Comparing Strategies to Introduce Two New Antibiotics for Gonorrhea: A Modeling Study"
The reviews suggest that while the modeling provides valuable insights, further empirical data are needed before clinical translation.
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