Oral cefixime versus intramuscular ceftriaxone in patients with uncomplicated gonococcal infections.

A randomized trial was conducted to compare cefixime (400 mg or 800 mg single oral dose) with ceftriaxone (250 mg single intramuscular dose) in terms of efficacy and safety for the treatment of uncomplicated Neisseria gonorrhoeae urethritis or cervicitis. Of 75 men and 150 women screened, 187 had positive culture results for N. gonorrhoeae. The course of treatment was evaluable in 155 cases (59 men, 96 women). Bacteriologic eradication was evident in 97% (105 out of 108) of the patients treated with cefixime and in 100% (47 out of 47) of the patients treated with ceftriaxone. N. gonorrhoeae was eliminated at 98% (143 out of 146) and 100% (72 out of 72) of the infection sites in the respective treatment groups. Of the 187 isolates, 8 were penicillinase-producing (PPNG) and 20 had high-level tetracycline resistance (TRNG). The cefixime and ceftriaxone MIC90 for all 187 study isolates was 0.008 micrograms/ml. The adverse clinical experiences reported by the patients treated with cefixime (10%) were self-limiting; no adverse experiences occurred in the patients treated with ceftriaxone. Cefixime was as well tolerated and efficacious as ceftriaxone in the treatment of the patients with uncomplicated N. gonorrhoeae urethritis or cervicitis reported here.     

Ceftizoxime in the treatment of uncomplicated gonorrhoea.

A total of 74 men and 26 women with uncomplicated gonorrhoea were treated with ceftizoxime sodium 0.5 g intramuscularly. The cure rate was 99% and included successful treatment of four infections due to beta-lactamase producing organisms. The minimum inhibitory concentrations (MICs) of ceftizoxime in vitro were very much lower than those of penicillin and cefuroxime, and side effects were minimal. We conclude that ceftizoxime is effective against Neisseria gonorrhoeae in vivo and in vitro.     

Acrosoxacin in the treatment of uncomplicated gonorrhoea.

Acrosoxacin was given as a single 300 mg oral dose to 105 patients with acute gonorrhoea. Of the 100 patients followed completely there was a 93% cure rate and 33% of men developed postgonococcal urethritis (PGU). This compared with a 97% cure and 30% PGU with 2 megaunits penicillin. The in vitro activity of acrosoxacin in Nottingham against strains of Neisseria gonorrhoeae showed that it was a highly active agent with 90% of strains inhibited by a concentration of 0.03 mg/l.     

Augmentin compared with amoxycillin in treating uncomplicated gonorrhoea.

We studied 220 patients (138 men and 82 women) with uncomplicated gonorrhoea who were entered into a randomised double blind trial and treated with either Augmentin (amoxycillin 3 g and potassium clavulanate 125 mg) or amoxycillin 3 g, with probenecid 1 g by mouth in all cases. Seven (6.5%) of 108 patients treated with Augmentin were still culture positive after treatment, compared with 15 (13.4%) of 112 of those treated with amoxycillin. Penicillinase (beta lactamase) producing strains of Neisseria gonorrhoeae (PPNG) were found in 23 (10.5%) patients, of whom 10 were treated with Augmentin and 13 with amoxycillin. Treatment failed in all 13 patients who received amoxycillin. Augmentin was shown to be an effective treatment for gonorrhoea caused by PPNG strains.     

Single-dose treatment of uncomplicated gonorrhoea in males with minocycline.

Minocycline in a single 300 mg. oral dose was given to 103 men with uncomplicated gonorrhoea, of whom 85 were followed-up for at least 2 weeks. The cure rate in the 85 followed was 94.1 per cent. There were no side-effects. Thus minocycline could be considered as an effective and safe alternative to penicillin in the single-dose treatment of uncomplicated gonorrhoea in the male, but at the moment it is too expensive for routine use.     

Treatment of uncomplicated gonorrhoea with single dose aztreonam.

Infection with Neisseria gonorrhoeae was cleared in 61 men and 26 women at all sites (except in the pharynx of one male bisexual patient with urethral and pharyngeal gonorrhoea) after treatment with aztreonam as a single 1 g intramuscular injection. Aztreonam was well tolerated with no adverse effects. This monobactam antibiotic was effective against both penicillin sensitive and resistant strains.     

Underlying complement deficiency in patients with disseminated gonococcal infection

The complement system was evaluated in 22 individuals with disseminated gonococcal infection. Three of the 22 patients exhibited a total serum complement activity that was greater than 2 SD below the normal mean. Of these three, one had a complete deficiency of C1r, a second patient had pre-existing systemic lupus erythematosus with low levels of C4, and the third had a C8 concentration that was 60% of normal. We conclude that the prevalence of inherited or acquired complement deficiency among patients with disseminated gonococcal infection exceeds that among the general population and is an important host factor predisposing to systemic infection with Neisseria gonorrhoeae.     

Rosoxacin in the treatment of uncomplicated gonorrhoea in men.

Between 3 January and 4 March 1983 we treated 200 male patients diagnosed as having uncomplicated gonococcal urethritis with one of two regimens. They were divided into two groups and randomly assigned to treatment with either 2 g spectinomycin administered intramuscularly (group A) or 300 mg rosoxacin by mouth (group B). Of 187 isolates tested for the production of beta-lactamase, 101 (54%) were penicillinase producing Neisseria gonorrhoeae (PPNG) strains. All 81 cases followed in group A (spectinomycin) were cured, compared with 88.5% (77 out of 87) of the patients followed in group B (rosoxacin). We concluded that rosoxacin at a dosage of 300 mg administered orally was fairly effective in the treatment of gonococcal urethritis in men caused by both PPNG and non-PPNG strains.     

Ceftizoxime in the treatment of uncomplicated gonorrhoea

A total of 74 men and 26 women with uncomplicated gonorrhoea were treated with ceftizoxime sodium 0.5 g intramuscularly. The cure rate was 99% and included successful treatment of four infections due to beta-lactamase producing organisms. The minimum inhibitory concentrations (MICs) of ceftizoxime in vitro were very much lower than those of penicillin and cefuroxime, and side effects were minimal. We conclude that ceftizoxime is effective against Neisseria gonorrhoeae in vivo and in vitro.     

Acrosoxacin in the treatment of uncomplicated gonorrhoea

Acrosoxacin was given as a single 300 mg oral dose to 105 patients with acute gonorrhoea. Of the 100 patients followed completely there was a 93% cure rate and 33% of men developed postgonococcal urethritis (PGU). This compared with a 97% cure and 30% PGU with 2 megaunits penicillin. The in vitro activity of acrosoxacin in Nottingham against strains of Neisseria gonorrhoeae showed that it was a highly active agent with 90% of strains inhibited by a concentration of 0.03 mg/l.     

Two regimens of sultamicillin in treating uncomplicated gonorrhoea.

Sultamicillin is a covalent union of ampicillin and the beta lactamase inhibitor, sulbactam (CP-45,899). Two studies were conducted to assess its efficacy in treating uncomplicated gonorrhoea. In the first study treatment comprised sultamicillin 1.5 g and probenecid 1 g; 124 (89.2%) of 139 patients responded including seven of 11 patients harbouring beta lactamase (penicillinase) producing strains of Neisseria gonorrhoeae (PPNG). In the second study sultamicillin 2.25 g and probenecid 1 g were given; 122 (93.8%) of 130 patients responded. Only two of seven pharyngeal infections resolved, and if pharyngeal infections are excluded the overall cure rate rose to 95.3%. Thirteen of 14 patients infected with PPNG strains were cured by the larger dose. Side effects were mild and transitory. It may be concluded that sultamicillin 2.25 g plus probenecid 1 g is an effective regimen to treat uncomplicated rectal and genital gonorrhoea and is useful for treating infections with PPNG strains. Most beta lactamase resistant antimicrobials must be given parenterally; sultamicillin is given by mouth.