Resistance of uropathogens to gepotidacin: A systematic review of in vitro antimicrobial susceptibility studies.

INTRODUCTION

Gepotidacin is a new triazaacenaphthylene antibiotic approved for the treatment of female patients with uncomplicated urinary tract infections. Its bactericidal activity stems from its unique ability to inhibit both DNA gyrase and topoisomerase IV.

METHODS

A systematic search was conducted in PubMed, Embase, Web of Science, and Scopus for relevant publications. US Food and Drug Administration resistance breakpoints were used.

RESULTS

An analysis of 23 711 isolates from 15 studies demonstrated a consistently low resistance to gepotidacin across various bacterial species and resistance phenotypes. Among Enterobacterales isolates, the resistance and intermediate category was 0%-6.8% and 0%-8%, respectively. For Gram-positive bacterial uropathogens, susceptibility to gepotidacin was 99.2% and 100% in 2 studies for Enterococcus faecalis isolates and ranged from 66.7% to 100% for Staphylococcus saprophyticus isolates. Resistance among extended-spectrum β-lactamase-producing Enterobacterales isolates ranged from 0% to 0.6%. Resistance among multidrug-resistant (MDR), defined as resistant to ≥3 relevant antibacterial classes, Gram-negative uropathogen isolates (323 MDR Escherichia coli, 27 MDR Klebsiella pneumoniae, and 21 MDR Proteus mirabilis in one study, as well as 244 MDR E. coli isolates in another study) was 0%. Similarly, resistance to gepotidacin was 0% in Enterobacterales isolates resistant to ampicillin, amoxicillin-clavulanic acid, mecillinam, cefadroxil, fluoroquinolones, fosfomycin, nitrofurantoin, and trimethoprim-sulfamethoxazole.

CONCLUSIONS

Gepotidacin has very good antimicrobial activity against a variety of pathogens that cause uncomplicated urinary tract infections. Importantly, it retains activity against uropathogen isolates that exhibit resistance to other antibiotics commonly used for UTIs, making it a useful addition to a physician's therapeutic arsenal.