A professor at UCLA says he has created a genetic test that can determine which gonorrhea patients can be treated with an antibiotic that has fallen into disuse, an innovation that could help reduce the spread of resistance to a drug commonly used to treat the illness .
The test was developed by Dr. Jeffrey Klausner, who teaches medicine and public health at UCLA. It reveals which patients have a type of gonorrhea that can be treated with ciprofloxacin, or Cipro, which the Centers for Disease Control and Prevention stopped recommending in 2007 because of increasing resistance to the drug.
The test can also determine whether a patient has developed resistance to Cipro, says Klausner, pointing to studies that prove that Cipro is highly effective in such cases.
The CDC currently recommends the treatment of gonorrhea with two antibiotics – one injection of ceftriaxone and one pill, azithromycin. Public health experts say they have detected increased resistance to azithromycin.
“People are … essentially treated with a deck,” says Klausner. “It would be much better if we could make a smarter treatment and treat them based on the susceptibility or genetic characteristics of the infection they actually have.”
Providers began using laboratory testing at two UCLA hospitals, two emergency departments and about 150 primary care clinics in November 2015.
Klausner compared the treatment of gonorrhea during the eleven months before UCLA began using the test and eight months later. He found that after the test, Cipro’s use increased from zero to 34 percent of cases, according to a report in the journal Clinical Infectious Diseases.
“They increase resistance by giving people drugs that do not treat them effectively,” says Klausner. “We will not increase resistance by treating susceptible cases of gonorrhea with Cipro.”
“We have to be able to use the best drug for the infection that the patient has and not just one size for everyone,” he adds.
KPCC asked the CDC whether it supports the use of a genetic test to determine the best treatment for individual cases of gonorrhea and whether it supports the idea of doctors treating patients with Cipro when appropriate.
The agency said in a statement that the current body of evidence on “trends in susceptibility to antibiotics and emerging signs of resistance … supports the use of dual therapy with azithromycin and ceftriaxone. This treatment remains effective and can help prevent resistance to both antibiotics. ”
The CDC added that “the limited number of treatment options available underscores the need to develop new antibiotic agents, and CDC encourages research and innovation to determine which safe and effective combination therapies may also be available.”
Klausner says he would like to see other health systems use their test before treating gonorrhea cases. He also hopes that researchers will develop similar tests to determine if other older antibiotics could be used to treat the infection.
“The more options we have, the better we can control this epidemic of drug-resistant gonorrhea,” he says.
Gonorrhea is the second most commonly reported disease in the country, according to the Centers for Disease Control and Prevention.