A myriad of landmark breakthroughs from 2025 demonstrate that the clinical impact of modern therapeutics – including gepotidacin as a new antimicrobial option for gonorrhoea – depends as much on disciplined hospital pharmacy implementation as it does on scientific innovation, as Dr João Gonçalves PhD explains as he shares part four of his top five highlights from 2025.
Among infectious disease publications in 2025, one of the most strategically important for hospital pharmacy was the EAGLE-1 phase 3 trial evaluating oral gepotidacin for the treatment of uncomplicated urogenital gonorrhoea.
The study, published in The Lancet in May, demonstrated its non-inferiority to ceftriaxone plus azithromycin and signalled a welcome expansion of the therapeutic toolkit in a domain under growing pressure from antimicrobial resistance.1
A linked commentary in the same journal framed the result in the broader context of resistance trends and the risk trajectory for gonorrhoea management if new options are not stewarded correctly.2
Navigating antimicrobial resistance and gepotidacin
In hospital pharmacy, the key issue is that the value of a new antimicrobial is as much ecological as it is individual. Oral convenience is a double-edged sword. It can improve adherence and streamline care, especially in settings where injectable administration creates access barriers.
At the same time, increased oral availability raises the risk of inappropriate empiric use, prescribing outside evidence-based criteria, and the development of resistance through uncontrolled deployment. The initial year of use often determines the drug’s clinical trajectory.
Hospital pharmacists, particularly those embedded in antimicrobial stewardship programmes, are positioned to determine whether gepotidacin becomes a durable asset or a short-lived novelty. The scientifically coherent approach is to integrate the agent into a stewardship pathway that links diagnostic confirmation, prescribing criteria, follow-up, and resistance surveillance.
Emergency and urgent care settings are essential because gonorrhoea treatment is often started immediately. The hospital pharmacist’s role is therefore not only to restrict the medication but also to promote its correct use: through clear guidelines, point-of-care education, electronic prescribing defaults aligned with policy, and audit-and-feedback processes.
The broader point is that this study reminds us that antimicrobial innovation only becomes valuable to the health system when stewardship is approached as implementation science. Gepotidacin’s trial evidence is strong enough to warrant attention; the role for pharmacy is to prevent this signal from being obscured by uncontrolled practice.
Next read the fifth and final part of this 2025 highlights series on medication safety and artificial intelligence and make sure to catch up on part one on CAR-T therapy for autoimmune disease, part two on radioligand therapy for prostate cancer and part three on tirzepatide in heart failure.
Author
João Gonçalves PharmD PhD
Faculty of Pharmacy, University of Lisbon and Imed Research Institute for Medicines, Lisbon, Portugal
References
1 Ross JDC et al. Oral gepotidacin for the treatment of uncomplicated urogenital gonorrhoea (EAGLE-1): a phase 3 randomised, open-label, non-inferiority, multicentre study. Lancet 2025;405(10489):1608–20.
2 Unemo M. Gepotidacin shows promise for the treatment of uncomplicated gonorrhoea. Lancet 2025;405(10489):1560–2.
