Adaptive guidelines for the treatment of gonorrhea to increase the effective life span of antibiotics among men who have sex with men in the United States: A mathematical modeling study
Adaptive guidelines for the treatment of gonorrhea to increase the effective life span of antibiotics among men who have sex with men in the United States: A mathematical modeling study
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DOI：
10.1371/journal.pmed.1003077
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发表时间：
2020-04-01
期刊：
影响因子：
15.8
通讯作者：
Grad, Yonatan H.
中科院分区：
文献类型：
--
作者：
Yaesoubi, Reza;Cohen, Ted;Grad, Yonatan H.
淋球菌耐药性的增加强调了延长抗生素临床使用寿命的策略的必要性。因为有有限的证据来支持目前的做法，切换经验性的一线抗生素时，耐药超过5%的人口，我们的目标是比较的影响，替代策略的有效寿命的抗生素和整体负担gonorhealth.Methods和findingsWe开发和校准的数学模型淋病传播的男性与男性发生性关系（MSM）在美国。我们校准了模型，以估计淋病的患病率，淋病病例的发生率，以及在美国男男性接触者中出现症状的病例比例。我们使用这个模型来预测抗生素的有效寿命，以及在50年的模拟期内，在当前和替代监测策略下预期的淋病病例数量。我们证明，与目前的做法相比，使用季度（而不是每年）监测估计并结合估计的耐药性流行率和耐药性流行趋势来确定治疗指南的策略可以将抗生素的有效寿命延长0.83年。这相当于每年每100，000名MSM人群中使用一线抗生素成功治疗额外的80.1例（95%不确定性区间：[47.7，111.9]）淋病病例，而不会加重淋病负担。如果每年检测药物敏感性的分离株数量增加一倍，这种策略可以将抗生素的有效寿命延长0.94年，相当于每年每10万MSM人群中成功治疗91.1例淋病病例，而不会增加淋病的发病率。研究的局限性包括，我们的结论可能无法推广到其他环境，因为我们的模型描述了淋病在美国MSM人群中的传播，为了更好地捕捉当前和未来抗生素特征的不确定性，我们选择了与淋病治疗中常用的抗生素具有相似特征的假设药物进行建模。结论我们的结果表明，使用来自监测项目的数据可以扩大使用抗生素的范围，以延长抗生素的临床有效性，而不增加疾病负担。这突出表明，必须维持有效的监测系统，并让决策者参与，将监测结果转化为及时和有效的决定。
BackgroundThe rise of gonococcal antimicrobial resistance highlights the need for strategies that extend the clinically useful life span of antibiotics. Because there is limited evidence to support the current practice of switching empiric first-line antibiotic when resistance exceeds 5% in the population, our objective was to compare the impact of alternative strategies on the effective life spans of antibiotics and the overall burden of gonorrhea.Methods and findingsWe developed and calibrated a mathematical model of gonorrhea transmission among men who have sex with men (MSM) in the United States. We calibrated the model to the estimated prevalence of gonorrhea, the rate of gonorrhea cases, and the proportion of cases presenting symptoms among MSM in the US. We used this model to project the effective life span of antibiotics and the number of gonorrhea cases expected under current and alternative surveillance strategies over a 50-year simulation period. We demonstrate that compared to the current practice, a strategy that uses quarterly (as opposed to yearly) surveillance estimates and incorporates both the estimated prevalence of resistance and the trend in the prevalence of resistance to determine treatment guidelines could extend the effective life span of antibiotics by 0.83 years. This is equivalent to successfully treating an additional 80.1 (95% uncertainty interval: [47.7, 111.9]) gonorrhea cases per 100,000 MSM population each year with the first-line antibiotics without worsening the burden of gonorrhea. If the annual number of isolates tested for drug susceptibility is doubled, this strategy could increase the effective life span of antibiotics by 0.94 years, which is equivalent to successfully treating an additional 91.1 (54.3, 127.3) gonorrhea cases per 100,000 MSM population each year without increasing the incidence of gonorrhea. Study limitations include that our conclusions might not be generalizable to other settings because our model describes the transmission of gonorrhea among the US MSM population, and, to better capture uncertainty in the characteristics of current and future antibiotics, we chose to model hypothetical drugs with characteristics similar to the antibiotics commonly used in gonorrhea treatment.ConclusionsOur results suggest that use of data from surveillance programs could be expanded to prolong the clinical effectiveness of antibiotics without increasing the burden of the disease. This highlights the importance of maintaining effective surveillance systems and the engagement of policy makers to turn surveillance findings into timely and effective decisions.