Emerging Antimicrobial Strategies and Stewardship Challenges

Zoliflodacin shows potent in vitro activity against contemporary multidrug-resistant Neisseria gonorrhoeae, suggesting a promising therapeutic option for difficult-to-treat infections. Testing across a broad collection of recent clinical isolates from a high-burden urban surveillance network found consistent inhibitory effects, supporting relevance against circulating resistant gonococcal strains.

A multicenter series of 876 urogenital isolates collected from 35 hospitals in Shanghai (2020–2023) provided the primary susceptibility dataset. Reported MICs for zoliflodacin ranged from ≤0.004 to 0.25 mg/L (MIC50 = 0.06 mg/L; MIC90 = 0.125 mg/L), all below the proposed 0.5 mg/L breakpoint. Zoliflodacin retained activity against isolates non-susceptible to ceftriaxone, azithromycin, ciprofloxacin, penicillin, and tetracycline, affirming maintained potency across tested resistant phenotypes.

No resistance-associated GyrB substitutions known to elevate zoliflodacin MICs were detected in the sequenced isolate set. The predominance of wild-type GyrB sequences implies preserved target integrity in the current population and creates a short-term stewardship window to preserve susceptibility while broader clinical use remains limited.