TREATMENT OF GONOCOCCAL INFECTIONS: SEARCHING FOR ALTERNATIVES

Ceftriaxone is well tolerated and as effective as cefoxitin In a study comparing the relative efficacies of cefoxitin and the newer cephalosporin ceftriaxone, 128 men with penicillin-resistant gonococcal urethritis were randomly assigned to receive either 250mg IM ceftriaxone, or 2g IM cefoxitin with lg oral probenecid. Ali 61 patients treated with ceftriaxone and 66 of 67 patients treated with cefoxitin were cured. The 1 treatment failure was cured with 2g IM spectinomycin. The MIC for penicillin-resistant strains of Neisseria gonorrhoeae was 0.42 J.Lgfml for cefoxitin and 0.003 J.Lg/m1 for ceftriaxone. For the penicillin-sensitive isolates these values were 0.59 J.Lgfml and 0.004 J.Lg/ml respectively. No patient receiving ceftriaxone reported pain at the injection site but several patients receiving cefoxitin felt moderate pain lasting up to several hours. No other side effects were noted.

Both antibiotics were effective against both penicillinase-producing and penicillin-sensitive strains of N. gonorrhoeae. The striking absence of pain and the small amount of injected drug required make ceftriaxone a potential alternative to cefoxitin or spectinomycin in the treatment of gonococcal urethritis. Zajdowicz, T.R. et al.: British Journal of Venereal Diseases 59: 176 (Jun 1983)

Cefuroxime and thiamphenicol constitute alternatives to penicillin The effectiveness of cefuroxime and thiamphenicol in the treatment of uncomplicated gonococcal infection was studied in 428 women (562 episodes of infection). Patients were classified into 2 groups, those with infections due to penicillinase-producing Neisseria gonorrhoeae (PPNG) and those with infections due to non-PPNG. The treatment regimens were: 1.5g IM cefuroxime + lg probenecid orally, or 2.5g thiamphenicol orally, or 2g IM spectinomycin (PPNG group); or 4.8 megaunits IM procaine penicillin + lg probenecid orally (non-PPNG group). Cefuroxime + probenecid was highly effective in treating infections due to PPNG and was superior to penicillin against non-PPNG. The failure rates for cefuroxime were 1. 7% and 1.5% for PPNG and non-PPNG respectively. Thiamphenicol was effective against PPNG (only 1. 7% treatment failures) but the failure rate in infections with non­PPNG was high (7.5%). This is not significantly different from the failure rate with penicillin (8. 7%). The thiamphenicol failure rate appeared to be related to the MIC, since MICs of 2.0 J.Lg/ml or more resulted in 8 out of 47 failures compared with only l out of 47 with MICs of 1.0 J.Lg/ml or less. Thiamphenicol might therefore be used as an alternative in infections with PPNG strains. If thiamphenicol is used widely, however, resistant strains may be selected and result in an increased number of treatment failures. The 8.7% failure with penicillin in non-PPNG infections shows a high level of resistance and penicillin may not be appropriate (in the dose recommended) as the primary treatment for gonococcal infection, even when it is due to non­PPNG strains. The routine use of penicillin is not recommended unless penicillinase production can be first excluded by an appropriate screening test. Tupasi, T.E. et al.: British Journal of Venereal Diseases 59: 172 (Jun 1983)

0156-2703/83/0827-0007/0$01.00/0 © ADIS Press INPHARMA 27 Aug 1983 7