Terapi Gonore Resisten: Evaluasi Klinis Terhadap Strategi Pengobatan Dan Alternatif Oral

Roby Syah Putra Firmansyah, Elitha Sundari Pulungan, Charlos Daniel Lahuwang, Ismalia Husna, Dian Andriani Ratna Dewi, Amin Ibrizatun

Sari


Neisseria gonorrhoeae semakin menunjukkan resistensi terhadap antibiotik lini pertama seperti ceftriaxone dan azitromisin, yang mempersulit penatalaksanaan infeksi dan meningkatkan risiko komplikasi serta transmisi berkelanjutan. Situasi ini menuntut pengembangan strategi terapi alternatif yang lebih efektif, aman, dan dapat diterapkan secara luas di berbagai sistem pelayanan kesehatan. Artikel ini bertujuan untuk mengevaluasi bukti klinis primer terkait dua pendekatan terapi alternatif, yaitu modifikasi regimen konvensional dan terapi oral inovatif, dalam menangani gonore resisten. Penelusuran literatur dilakukan melalui database PubMed, ScienceDirect, SpringerLink, MDPI, dan BMC Infectious Diseases. Lima uji klinis primer fase II/III yang dipublikasikan dalam sepuluh tahun terakhir dipilih dan dianalisis secara kualitatif menggunakan pendekatan sintesis tematik naratif. Hasil telaah menunjukkan bahwa regimen ceftriaxone dosis tinggi (1 g IM) dan kombinasi gentamicin-azitromisin memiliki efektivitas eradikasi mikrobiologis yang tinggi (>90%) untuk infeksi urogenital, namun efektivitas menurun pada infeksi faring dan rektal. Gentamicin menjadi alternatif yang layak pada pasien dengan alergi sefalosporin, meski dengan efek samping lebih tinggi. Agen oral baru seperti gepotidacin dan zoliflodacin menunjukkan eradikasi >95% dalam uji fase 2, terutama untuk infeksi urogenital, dengan profil keamanan yang baik, namun efektivitas terhadap infeksi faring masih inkonsisten. Dapat disimpulkan bahwa belum terdapat strategi tunggal yang optimal untuk seluruh kasus gonore resisten. Pemilihan terapi sebaiknya mempertimbangkan lokasi infeksi, profil resistensi lokal, dan ketersediaan obat. Terapi oral inovatif menjanjikan, namun memerlukan validasi klinis lebih lanjut untuk penerapan luas.


Kata Kunci


Neisseria gonorrhoeae; Resistensi antibiotik; Ceftriaxone dosis tinggi; Gentamicin; Gepotidacin; Zoliflodacin; Terapi oral alternatif

Teks Lengkap:

PDF

Referensi


Ageeb RA, Almukdad S, Alalami H, Harfouche M, Abu-Raddad LJ. Epidemiology of Neisseria gonorrhoeae in South-East Asia: systematic review, meta-analyses, and meta-regressions. J Infect. 2025;91(2):106545. doi:10.1016/j.jinf.2025.106545

Bízová B, Bořil P, Kubele J, et al. Single-dose cefixime 800 mg plus doxycycline 100 mg twice a day for 7 days compared with single-dose ceftriaxone 1 g plus single-dose azithromycin 2 g for treatment of urogenital, rectal, and pharyngeal gonorrhoea: an open-label, non-inferiority, randomised trial. Clin Microbiol Infect. 2024;30(3):211–215. doi:10.1016/j.cmi.2023.11.006

Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N. Engl. J. Med. 2015;372:2039–2048. doi: 10.1056/NEJMra1411426.

Centers for Disease Control and Prevention (CDC). Sexually transmitted infections treatment guidelines [Internet]. 2024 [cited 2025 Jul 3]

Crew PE, Abara WE, McCulley L, Waldron PE, Kirkcaldy RD, Weston EJ, Bernstein KT, Jones SC, Bersoff-Matcha SJ. Disseminated gonococcal infections in patients receiving eculizumab: A case series. Clin Infect Dis. 2019;69(4):596-600. doi: 10.1093/cid/ciy958.

Global Priority List of Antibiotic-Resistant Bacteria. World Health Organization; Geneva, Switzerland: 2017. [cited 2025 Jul 12]. Available from: https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed

Guvenc F, Kaul R, Gray-Owen SD. Intimate relations: Molecular and immunologic interactions between Neisseria gonorrhoeae and HIV-1. Front Microbiol. 2020;11:1299. doi: 10.3389/fmicb.2020.01299.

Hananta IPY, Kaldor J, Guy R, et al. Prevalence of asymptomatic sexually transmitted infections among key populations in Indonesia: findings from targeted surveillance. Sex Transm Infect. 2016;92(6):477–82. doi:10.1136/sextrans-2015-052421

Jennison AV, Whiley DM, Lahra MM, Graham RM, Cole MJ, Hughes G, et al. Genetic relatedness of ceftriaxone-resistant and high-level azithromycin resistant Neisseria gonorrhoeae cases, United Kingdom and Australia, February to April 2018. Euro Surveill. 2019;24(8):1900118. doi:10.2807/1560-

ES.2019.24.8.1900118

Kondracki AJ, Li W, Bursac Z, Mokhtari M, Reddick B, Barkin JL. Interaction effects of maternal sexually transmitted infections with prenatal care utilization status on preterm birth and low birthweight: U.S. national data. J Clin Med. 2022;11(17):5184. doi: 10.3390/jcm11175184.

Medland NA, Zhang Y, Gunaratnam P, Lewis DA, Donovan B, Whiley DM, Guy RJ, Kaldor JM. Surveillance systems to monitor antimicrobial resistance in Neisseria gonorrhoeae: A global, systematic review, 1 January 2012 to 27 September 2020. Euro Surveill. 2022;27(18):2100917. doi: 10.2807/1560-7917.ES.2022.27.18.2100917.

Philibert P, Khiri H, Pénaranda G, Camus C, Drogoul MP, Halfon P. High prevalence of asymptomatic sexually transmitted infections among men who have sex with men. J Clin Med. 2014;3(4):1386-91. doi: 10.3390/jcm3041386.

Raccagni AR, Ranzenigo M, Bruzzesi E, Maci C, Castagna A, Nozza S. Neisseria gonorrhoeae antimicrobial resistance: The future of antibiotic therapy. J Clin Med. 2023;12(24):7767. doi: 10.3390/jcm12247767.

Rob F, Klubalová B, Nýčová E, Hercogová J, Unemo M. Gentamicin 240 mg plus azithromycin 2 g vs ceftriaxone 500 mg plus azithromycin 2 g for treatment of rectal and pharyngeal gonorrhoea: a randomized controlled trial. Clin Microbiol Infect. 2020;26(2):207–12. doi:10.1016/j.cmi.2019.08.004

Ross JDC, Brittain C, Cole M, et al. Gentamicin compared with ceftriaxone for the treatment of gonorrhoea (G-TOG): a randomised non-inferiority trial. Lancet. 2019;393(10190):2511–20. doi:10.1016/S0140-6736(18)32817-4

Ross JDC, Wilson J, Workowski KA, Taylor SN, Lewis DA, Gatsi S, et al. Oral gepotidacin for the treatment of uncomplicated urogenital gonorrhoea (EAGLE-1): a phase 3 randomised, open-label, non-inferiority, multicentre study. Lancet. 2025;405(10333):1608–20. doi:10.1016/S0140-6736(25)00628-2

Taylor SN, Marrazzo J, Batteiger BE, Hook EW, Seña AC, Long J, et al. Single-dose zoliflodacin (ETX0914) for treatment of uncomplicated urogenital gonorrhea. N Engl J Med. 2018;379(19):1835–45. doi:10.1056/NEJMoa1706988

World Health Organization. Gonorrhoea (Neisseria gonorrhoeae infection) [Internet]. Geneva: WHO; 2023 [cited 2025 Jul 14]. Available from: https://www.who.int/news-room/fact-sheets/detail/gonorrhoea-(neisseria-gonorrhoeae-infection)

WHO Guidelines for the Treatment of Neisseria Gonorrhoeae. World Health Organization; Geneva, Switzerland: 2016. [cited 2025 Jul 12]. Available from: https://www.who.int/publications-detail-redirect/9789241549691

World Health Organization. Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP): Surveillance Report 2023. Geneva: WHO; 2024. Licence: CC BY‑NC‑SA 3.0 IGO. pp 23-24




DOI: https://doi.org/10.33024/jikk.v12i10.22546

Refbacks

  • Saat ini tidak ada refbacks.


##submission.copyrightStatement##

##submission.license.cc.by-nc4.footer##

Pendidikan Dokter Universitas Malahayati Lampung


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.