부산대학교 도서관

Background: Since common diagnostic tests for gonorrhea do not provide information about susceptibility to antibiotics, treatment of gonorrhea remains empiric. Antibiotics used for empiric therapy are usually changed once resistance prevalence exceeds a certain threshold (e.g., 5%). A low switch threshold is intended to increase the probability that an infection is successfully treated with the first-line antibiotic, but it could also increase the pace at which recommendations are switched to newer antibiotics. Little is known about the impact of changing the switch threshold on the incidence of gonorrhea, the rate of treatment failure, and the overall cost and quality-adjusted life-years (QALYs) associated with gonorrhea. Methods and findings: We developed a transmission model of gonococcal infection with multiple resistant strains to project gonorrhea-associated costs and loss in QALYs under different switch thresholds among men who have sex with men (MSM) in the United States. We accounted for the costs and disutilities associated with symptoms, diagnosis, treatment, and sequelae, and combined costs and QALYs in a measure of net health benefit (NHB). Our results suggest that under a scenario where 3 antibiotics are available over the next 50 years (2 suitable for the first-line therapy of gonorrhea and 1 suitable only for the retreatment of resistant infections), changing the switch threshold between 1% and 10% does not meaningfully impact the annual number of gonorrhea cases, total costs, or total QALY losses associated with gonorrhea. However, if a new antibiotic is to become available in the future, choosing a lower switch threshold could improve the population NHB. If in addition, drug-susceptibility testing (DST) is available to inform retreatment regimens after unsuccessful first-line therapy, setting the switch threshold at 1% to 2% is expected to maximize the population NHB. A limitation of our study is that our analysis only focuses on the MSM population and does not consider the influence of interventions such as vaccine and common use of rapid drugs susceptibility tests to inform first-line therapy. Conclusions: Changing the switch threshold for first-line antibiotics may not substantially change the health and financial outcomes associated with gonorrhea. However, the switch threshold could be reduced when newer antibiotics are expected to become available soon or when in addition to future novel antibiotics, DST is also available to inform retreatment regimens. Using a mathematical model of gonococcal infection, Xuecheng Yin and co-authors project the burden of gonorrhea in a population of men who have sex with men in the US and, the gonorrhea-associated costs and loss in quality adjusted life-years under various antibiotic switch thresholds and scenarios for antibiotic availability. Author summary: Why was this study done?: Antibiotics used for the empiric therapy of gonorrhea are usually changed once the prevalence of resistance to the antibiotic exceeds a certain threshold, currently set at 5%. A low switch threshold is often selected to ensure that the first-line antibiotic remains effective for most patients with gonorrhea. However, little is known about the impact of changing the switch threshold on the incidence of gonorrhea, the rate of treatment failure, and the overall cost and quality-adjusted life-years (QALYs) associated with gonorrhea. What did the researchers do and find?: We developed a mathematical model of gonococcal infection among a population of men who have sex with men (MSM) in the United States to project the burden of gonorrhea and the overall associated cost and QALYs under various switch thresholds and scenarios for the future availability of antibiotics and drug-susceptibility testing (DST). We found that changing the switch threshold between 1% and 10% does not meaningfully impact the annual number of gonorrhea cases, and total cost and total QALY loss associated with gonorrhea. However, if a new antibiotic is expected to become available in the future choosing a lower threshold could improve the population net health benefit (NHB). What do these findings mean?: Changing the switch threshold may not substantially impact the health and financial outcomes associated with gonorrhea. However, the switch threshold could be reduced when newer antibiotics are expected to become available soon or when DSTs is available to inform retreatment regiments. Our study was limited to MSM in the US and future studies should evaluate the generalizability of our findings to other populations. [ABSTRACT FROM AUTHOR]