A case of skin rash during oral administration of a novel androgen receptor inhibitor, darolutamide

and antimicrobial susceptibility testing is available (which can take a few days). The use of intramuscular ceftriaxone requires significant clinical resources; however, the number of patients involved are likely to be low and the advantages of using ceftriaxone in terms of antimicrobial stewardship outweigh this. We accept that a few MSM with STEI may have gonorrhoea co-infection; however, the 2 g dose of ceftriaxone is extremely unlikely to induce antimicrobial resistance and will treat most strains of gonorrhoea. Furthermore, the number of MSM with gonorrhoea co-infection is likely to be very small and high dose ceftriaxone in this setting will not contribute significantly to AMR. Overall, we propose that as far as possible, only MSM with confirmed shigella with available sensitivities should be considered for antimicrobial treatment and in most cases this is unnecessary The most effective and safe presumptive antimicrobial agent for treating suspected STEI is currently unknown. The increasing use of molecular, culture-independent diagnostic tests for STEIs makes it difficult to identify outbreaks of multidrugresistant organisms and provide laboratory informed antimicrobial treatment. The use of point of care STI testing may reduce the inadvertent treatment of STIs in cases of MSM with diarrhoea. Consequently, robust public health surveillance of multidrug-resistant pathogen transmission remains a challenge. However, advances in molecular diagnostics will allow effective and rapid identification of genetic resistance markers within clinical algorithms, which may reduce emerging AMR and improve both patient care and antimicrobial stewardship for STEIs.