SYMPOSIUM
FIGURE 1. DISCOVERY OF ANTIBIOTICS, DEVELOPMENT OF ANTIMICROBIAL-RESISTANT ORGANISMS
Antibiotic resistance identified penicillin-R Staphylococcus 1940
Antibiotic introduced tetracycline-R Shigella 1959
methicillin-R Staphylococcus 1962 penicillin-R Pneumococcus 1965
erythromycin-R Staphylococcus 1968 gentamicin-R Enterococcus 1979
ceftazidime-R Enterobacteriaceae 1987 vancomycin-R Enterococcus 1988
levofloxacin-R Pneumococcus 1996 imipenem-R Enterobacteriaceae 1998 XDR tuberculosis 2000
linezolid-R Staphylococcus 2001 vancomycin-R Staphylococcus 2002
2003 diaptomycin
PDR-Acinetobacter and Pseudomonas 2004–05
ceftriaxone-R Neisseria gonorrhoeae PDR- Enterobacteriaceae 2009
2010 ceftaroline ceftaroline-R Staphylococcus 2011 R = resistant; XDR = extremely drug resistant; PDR = pan-drug resistant 1996 levofloxacin
1967 gentamicin 1972 vancomycin 1985 imipenem and ceftazidime
1943 penicillin 1950 tetracycline 1953 erythromycin 1960 methicillin
associated genetic lineage of MRSA is particularly worrisome.12
For all these
reasons, CDC catalogued MRSA as a serious threat requiring active sur- veillance and research efforts.
• Neisseria gonorrhoeae. Gonorrhea is a sexually transmitted disease (STD) that can affect the urethra, cervix, pharynx, or rectum and that clas- sically produces inflammation and discharge in the affected area. Gon- orrhea is one of the most frequent STDs in the country, with CDC es- timates of more than 800,000 new cases every year. Recent data suggest these numbers are increasing. When left untreated, gonorrhea can cause serious health problems that include chronic pelvic pain, life-threatening ectopic pregnancy, and even infer- tility. Infection (symptomatic or as- ymptomatic) also increases the risk of contracting and transmitting HIV. Although historically antibiotics
2000 linezolid
have successfully treated gonorrhea, N. gonorrhoeae is capable of adapting and developing resistance to nearly every drug recommended for treat- ment. For many years, the treatment of choice for gonorrhea was penicillin. However, an important proportion of N. gonorrhoeae isolates are now highly resistant to penicillin and other ß-lactams.13
CDC estimates gonococ-
cal organisms resistant to at least one antibiotic are responsible for around 246,000 U.S. cases of gonorrhea annu- ally. A July 2016 publication from the Gonococcal Isolate Surveillance Proj- ect reported an increase of more than 300 percent in the number of isolates exhibiting resistance to azithromy- cin.14
Azithromycin is a crucial com-
Source: Reproduced from the U.S. Centers for Disease Control and Prevention (CDC) website,
www.cdc.gov/drugresistance/about.html
50 TEXAS MEDICINE February 2017
ponent of the currently recommended therapeutic regimen that consists of a combination of azithromycin plus cef- triaxone. Note: No treatment failures to that regimen have been reported to date; however, increasing rates of re- sistance to azithromycin could jeop- ardize the effectiveness of the current standard of care.
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