Zoliflodacin and gepotidacin cross-resistance in Neisseria gonorrhoeae

Abstract

Resistance to zoliflodacin, a first-in-class antibiotic for gonorrhea treatment, can occur through gyrBD429N, but this mutations impact on fitness and resistance to other topoisomerase targeting drugs, including gepotidacin, have been unclear. Here, we show that gyrBD429N confers cross-resistance to gepotidacin in some clinical isolates and that its fitness effect varies with strain back-ground. These findings inform strategies for introducing the new topoisomerase inhibitors into clinical use and for surveillance of resistance.