Loss of exclusivity of ceftazidime/avibactam in low- and middle-income countries: a test for antibiotic stewardship practice.

Ceftazidime/avibactam is a last-line antibiotic, to be used as a targeted therapy for certain carbapenem-resistant Gram-negative infections and not to be used as an empirical therapy or as a carbapenem-sparing therapy. After a span of 5 years, the antibiotic recently lost its exclusivity and become a generic drug in India. It is assumed that generic players will aggressively market the drug, making it freely available even in pharmacies catering to primary- and secondary-care hospitals. We thus foresee certain potential adverse implications of introducing generic versions of ceftazidime/avibactam into the Indian market; as they will be a challenge to the antibiotic stewardship. In the real world scenario, the stewardship system in India is fragile, therefore, we may see empirical use of ceftazidime/avibactam even in primary and secondary-care hospitals. The existing widespread prevalence of MBL-producing isolates in India, will be further enhanced by the indiscriminate use of ceftazidime/avibactam.

Selection of DNA Aptamers Against Neisseria gonorrhoeae Causing Sexually Transmitted Infection (STI).

Neisseria gonorrhoeae (NG) is the second most common bacterial sexually transmitted infection (STI) worldwide. Gonorrhoea is a very serious infection because if untreated, it can lead to significant ramifications to reproductive, maternal, & newborn health and increase transmission of HIV. Infections are very often asymptomatic and symptoms when present manifest differently in men and women. The cornerstone of gonorrhoea control is to assure rapid diagnosis and prompt treatment of patients to prevent the onward spread of infection. The resource-rich settings are utilizing nucleic acid amplification tests (NAATs) for diagnosis, whereas resource-limited settings like ours where laboratory infrastructure is lacking, reliance is placed on syndromic approach. In view of the limitations of each, there is a compelling need for development of a point of care test (POCT). Aptamers offer such potential. These are short oligonucleotides that bind to its target with high affinity and specificity and therefore can be maneuvred for use in diagnostics. In this study, we performed live cell-SELEX (Systematic Evolution of Ligands by EXponential enrichment) to select 12 single-stranded DNA (ssDNA) aptamers that bind strongly to a cocktail of Neisseria gonorrhoeae strains, with Kd values ranging from 8.58 to 596 nM. Gold nanoparticle (GNP) assay revealed that one of the aptamers, E8 19 was highly specific for Neisseria gonorrhoeae (Kd = 24.5 nM). More importantly, it did not demonstrate any binding to Neisseria meningitidis and commensal Neisseria sp. The identified aptamer holds much promise for the development of a rapid test for diagnosis of gonorrhoea.