Original Title: Guide usage optimal: traitement pharmacologique des infections transmissibles sexuellement et par le sang – infections à chlamydia trachomatis et à Neisseria gonorrhoeae

Authors' objectives: In 2012, the Institut national d’excellence en santé et en services sociaux (INESSS) published a series of five optimal use guides on the pharmacological treatment of sexually transmitted and blood-borne infections (STBBIs), one of which was on uncomplicated Chlamydia trachomatis and Neisseria gonorrhoeae infections, which was updated in 2015. An update of the Canadian guidelines (CGs) was published in July 2017 in response to the withdrawal from the Canadian market of spectinomycin, an antibiotic previously recommended as an alternative treatment option for N. gonorrhoeae infections. In addition, there have been changes in Québec’s epidemiological landscape, specifically, an increase in the number of cases of rectal C. trachomatis infection and increased resistance of N. gonorrhoeae to antibiotics. INESSS has therefore updated the OUG on the treatment of STBBIs dealing with uncomplicated C. trachomatis and N. gonorrhoeae infections in order to update its recommendations to reflect the latest data. The objective of this report is to present all the data gathered for this update and the recommendations developed with the aim of judicious drug use.

Authors' results and conclusions: RESULTS: Minor changes have been made to the OUG to refine and clarify the section entitled “General Considerations”. Furthermore, the sections on management, follow-up and preventive measures have been adapted from the STBBI OUG on the syndromic approach published by INESSS in 2017. The main changes have been made to the section of the OUG concerning antibiotic therapy. First, the results of the systematic review indicate that there is no difference in the microbiologic cure rates observed between treatment with azithromycin (1 g PO as a single dose) and treatment with doxycycline (100 mg BID x 7 days) in urogenital C. trachomatis infections. These two treatment options are also proposed for this type of infection in the different CPGs that were consulted. Furthermore, the increased resistance of N. gonorrhoeae to azithromycin in Québec is raising some concerns. Consequently, azithromycin and doxycycline are now presented on an equal footing in the OUG for the treatment of urethral, cervical or pharyngeal C. trachomatis infections. Second, the Canadian guidelines now recommend treatment combining gentamicin (240 mg IM) and azithromycin (2 g PO as a single dose) as an alternative treatment option for N. gonorrhoeae infections in patients with a history of allergic reaction to cephalosporins or a penicillin antibiotic. Most of the CPGs consulted also recommend this treatment, and the results of the systematic review show a high microbiologic cure rate for treatment combining gentamicin (240 mg IM) and azithromycin (1 g PO as a single dose), although its efficacy is lower than that of treatment combining ceftriaxone (500 mg IM) and azithromycin (1 g PO as a single dose). Consequently, treatment combining gentamicin (240 mg IM) and azithromycin (2 g PO as a single dose) is now proposed in the OUG for treating N. gonorrhoeae infections in persons with a history of allergic reaction to cephalosporins, and a decision algorithm has been added for cases involving a history of allergic reaction to a penicillin antibiotic. CONCLUSION: With clinical recommendations concerning, among other things, pharmacological treatment and follow-up, this OUG will serve to guide and support health professionals in their practice. It may also help decrease the risk of spread of these infections in the community and the risk of an increase in the antibiotic resistance associated with the nonoptimal use of antibiotics.

Authors' methods: This update is based on the best available scientific data and on recommendations from clinical practice guidelines (CPGs) of good methodological quality, which were enriched with the experiential knowledge provided by different experts and clinicians, and with contextual aspects, extracted, among others, from government publications by the INSPQ and the Ministère de la Santé et des Services sociaux (MSSS) and data on antibiotic resistance observed in Québec. Furthermore, two systematic reviews of primary studies were conducted to supplement these data, one to evaluate the efficacy and safety of doxycycline and azithromycin in the treatment of rectal or urogenital C. trachomatis infections, the other to evaluate the efficacy and safety of gentamicin in combination with azithromycin in the treatment of N. gonorrhoeae infections. The results were enriched with legislative and organizational information specific to Québec and with the experiential knowledge provided by different Québec experts and clinicians who collaborated in this project.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/guides-dusage-optimal-sur-le-traitement-pharmacologique-des-itss-mise-a-jour-chlamydia-gonorrhoeae-aout-2020.html

Year Published: 2020

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/guides-dusage-optimal-sur-le-traitement-pharmacologique-des-itss-mise-a-jour-chlamydia-gonorrhoeae-aout-2020.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en santé et en services sociaux (INESSS)