Enhanced Surveillance of Antimicrobial-Resistant Gonorrhea System (ESAG): Antimicrobial use appropriateness

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• Why measure appropriateness of antimicrobial use?
• PHAC and provincial/territorial gonorrhea treatment guidelines from 2018 to 2023
• Figure 1: The proportion of ESAG cases who were prescribed a recommended vs non-recommended gonorrhea treatment regimen (among all ESAG cases who were prescribed treatment) among GBMSM and Other adults, 2018 to 2023

Why measure appropriateness of antimicrobial use?

ESAG measures the appropriateness of antimicrobial use by comparing the gonorrhea treatment regimens prescribed to ESAG cases with PHAC's and ESAG participating PTs' gonorrhea treatment guidelines. This indicator has been shown to be informative in making decisions to reduce AMR spread^{Reference 1}. To date, there is no known target for the ideal proportion of gonorrhea treatment guideline prescriber adherence to limit AMR-GC emergence. With time, ESAG data may inform such a target.

PHAC and provincial/territorial gonorrhea treatment guidelines from 2018 to 2023

PHAC regularly updates their gonorrhea treatment guidelines considering emerging antimicrobial-resistant gonorrhea trends. Between 2018 and 2023, PHAC gonorrhea treatment guidelines recommended prescribers refer to PT gonorrhea treatment guidelines (if available) before PHAC guidelines, as PT-specific guidelines reflect local gonorrhea and AMR-GC trend data. Alberta, Manitoba, and Northwest Territories all had their own guidelines, while New Brunswick and Nova Scotia followed PHAC gonorrhea treatment guidelines^{Reference 2Reference 3Reference 4}.

Between 2018 and 2023, Alberta, Manitoba and PHAC (and, thus, New Brunswick and Nova Scotia) gonorrhea treatment recommendations depended on if i) the site of GC infection was anogenital (i.e., cervical, rectal, and urogenital infections) or pharyngeal and ii) the client was a gay or bisexual man who has sex with men (GBMSM) or an ‘Other adult’ (Other adults include people ≥16 years old who are not a GBMSM). In contrast, the Northwest Territories gonorrhea treatment guidelines recommended the same treatment regimens for uncomplicated gonorrhea regardless of the site of infection or the client’s sexual behaviour.

Furthermore, PHAC and PT recommended gonorrhea treatment regimens were defined as preferred or alternative. An alternative treatment regimen was recommended over a preferred treatment regimen when there were contraindications to cephalosporins or if there were indications of emerging resistance or reduced drug supplies. Thus, it is appropriate for a clinician to prescribe a preferred or alternative therapy to a client.

In general, PHAC and all ESAG participating jurisdictions recommended a preferred or alternative dual therapy consisting of a third-generation cephalosporin (cefixime 800 mg or ceftriaxone 250 mg) in combination with azithromycin 1 g to treat uncomplicated gonorrhea regardless of the infection site or sexual behavior of the client. See the related resources for detailed PT gonorrhea treatment guidelines.

Figure 1. Proportion of ESAG cases prescribed a recommended vs non-recommended gonorrhea treatment regimen (among all ESAG cases who were prescribed treatment), by GBMSM and Other adults, 2018 to 2023

Download figure data in .csv format

Notes

• PHAC = The ESAG case was prescribed a gonorrhea treatment regimen recommended by PHAC’s gonorrhea treatment guidelines for the period 2018 to 2023
• PT = The ESAG case was prescribed a gonorrhea treatment regimen as recommended by their residing province or territory’s gonorrhea treatment guidelines for the period 2018 to 2023
• GBMSM = Gay, bisexual and other men-who-have-sex-with-men
• Other adults = Heterosexual males and all females but excludes males with unknown sexual behaviour
• Anogenital infections = Rectal and genital (i.e., cervical, urogenital and vaginal) gonococcal infections
• Pharyngeal infections = Throat gonococcal infections
• Not recommended treatment = Therapies not recommended by gonorrhea guidelines and unspecified prescribed treatment regimens

References