A comparison of penicillin G plus a beta-lactamase inhibitor (sulbactam) with spectinomycin for treatment of urethritis caused by penicillinase-producing Neisseria gonorrhoeae.

When combined with penicillin, sulbactam, a beta-lactamase inhibitor with weak intrinsic antibacterial activity, produces a marked synergistic effect in vitro against penicillinase-producing Neisseria gonorrhoeae. We compared a regimen of aqueous procaine penicillin G, sulbactam, and probenecid with spectinomycin for the treatment of uncomplicated gonococcal urethritis. Of 101 patients receiving the penicillin-sulbactam regimen, 97 (97%) were cured of their infection, as were 87 (95%) of 92 patients who received spectinomycin. Fifty per cent of patients were infected with penicillinase-producing N. gonorrhoeae; 43 (94%) of 46 treated with the penicillin-sulbactam regimen were cured as compared with 47 (92%) of 51 treated with spectinomycin. Neither regimen was associated with serious adverse effects. The results show that aqueous procaine penicillin G given with sulbactam and probenecid is an effective alternative for single-session therapy of urethritis caused by penicillinase-producing N. gonorrhoeae.

Treatment of penicillin-resistant Neisseria gonorrhoeae with oral norfloxacin.

Norfloxacin, an orally administered quinoline carboxylic acid that is structurally related to nalidixic acid, has been shown to be highly active in vitro against penicillinase-producing Neisseria gonorrhoeae. Ninety-two men with culture-proved gonococcal urethritis, 46 per cent with penicillinase-producing N. gonorrhoeae, and 27 per cent with non-penicillinase-producing N. gonorrhoeae that was resistant to penicillin were given either 1200 mg of norfloxacin divided into two equal oral doses four hours apart (59 patients) or 2 g of spectinomycin intramuscularly (33 patients). All patients in both treatment groups were cured. No adverse reactions were reported in either group. We conclude that a two-dose, single-day regimen of orally administered norfloxacin is effective therapy for uncomplicated urethritis caused by penicillin-resistant strains of N. gonorrhoeae.

Cefonicid as therapy for uncomplicated gonococcal urethritis caused by penicillinase-producing Neisseria gonorrhoeae.

Young men with uncomplicated gonococcal urethritis were treated with 1 gram of cefonicid given intramuscularly plus 1 gram of probenecid by mouth. Of 53 evaluable patients, 33 (62%) had penicillinase-producing Neisseria gonorrhoeae. All but one of these patients were cured. All men who had penicillin-sensitive infections were cured. Cefonicid was highly effective in the treatment of both penicillin-sensitive and penicillin-resistant N gonorrhoeae. Other than moderate pain at the site of injection, there were no adverse side effects. Cefonicid can be added to the group of newer cephalosporins that are effective in the treatment of gonococcal urethritis caused by either penicillin-sensitive or penicillin-resistant strains.

Laboratory-acquired gonococcal conjunctivitis: successful treatment with single-dose ceftriaxone.

Gonococcal conjunctivitis can be a severe disease with sequelae of corneal ulceration, hypopyon, and global perforation. Current recommended therapy is hospitalization and repeated courses of parenteral antibiotics. The authors report a case successfully managed with a single injection of the new third-generation cephalosporin, ceftriaxone.

Ceftizoxime (FK-749) is effective therapy for urethritis caused by penicillinase-producing Neisseria gonorrhoeae.

Fifty-five men with culture-proved gonococcal urethritis caused by either penicillin-sensitive or penicillinase-producing Neisseria gonorrhoeae were treated with 1 g of ceftizoxime given intramuscularly. All patients were cured, including 26 (47%) with penicillinase-producing strains. Patients experienced no local or systemic side effects and tolerated the injection of ceftizoxime well. These results show that ceftizoxime is an effective alternative to either spectinomycin or cefoxitin in treatment of uncomplicated gonococcal urethritis caused by penicillin-resistant bacteria.

Effectiveness of aztreonam, a new monobactam antibiotic, against penicillin-resistant gonococci.

Since the recognition of penicillinase-producing strains of N gonorrhoeae (PPNG) in 1976, these organisms have attained a worldwide distribution. The treatment of choice for infection due to PPNG has generally been spectinomycin administered im. In 1981, however, an infection from California was reported to be due to a strain of PPNG that was also resistant to spectinomycin (MIC, greater than 2,048 micrograms/ml) [1]. Throughout 1982, seven such isolates were reported worldwide [2], and in January 1983 an epidemiologically linked series of 27 cases of infection due to spectinomycin-resistant PPNG occurred in Korea. Because of the apparent declining utility of spectinomycin, we studied the efficacy and safety of aztreonam, a synthetic monobactam antibiotic from the Squibb Institute for Medical Research (Princeton, NJ) [3], in the treatment of acute uncomplicated gonococcal urethritis in men. Men with gonococcal urethritis were randomly treated with either 1 g of aztreonam or 2 g of spectinomycin im. Of the 112 men so treated, 93 could ultimately be evaluated: 51 who received aztreonam and 42 who received spectinomycin. Both drugs were 100% effective in the treatment of urethritis produced by both penicillin-sensitive and penicillin-resistant strains of gonococci. Furthermore, there were no reported side effects in either group and no laboratory abnormalities attributable to the aztreonam, with the exception of one patient with a minimally elevated level of serum glutamic oxaloacetic transaminase (serum glutamic pyruvic transaminase and alkaline phosphatase levels were normal).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of ceftriaxone with cefoxitin in the treatment of penicillin-resistant gonococcal urethritis.

Since cefoxitin has been shown to be an effective alternative to spectinomycin for the treatment of infections due to penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) its efficacy was compared with that of a new cephalosporin, ceftriaxone (R013-9904). One hundred and twenty eight men with culture-confirmed gonococcal urethritis were treated with either 250 mg of ceftriaxone intramuscularly or 2 g of cefoxitin intramuscularly with oral probenecid 1 g. The incidence of penicillin-resistant strains in each group was about 60%. Ceftriaxone was completely effective in treating both penicillin-sensitive and penicillin-resistant gonococcal urethritis. No side effects were noted. Ceftriaxone thus seems to be an effective and safe alternative to either spectinomycin or cefoxitin in the treatment of penicillin-resistant gonococcal urethritis.

In vitro antimicrobial activity of eight new beta-lactam antibiotics against penicillin-resistant Neisseria gonorrhoeae.

Increasing numbers of cases of penicillin-resistant gonorrhea necessitate the evaluation of new antibiotics for treatment of this disease. We tested the susceptibility of 92 penicillinase-producing (PP) Neisseria gonorrhoeae isolates and 88 penicillin-susceptible (PS) isolates to eight new beta-lactam antibiotics. The minimal inhibitory concentrations of these antibiotics were determined by the agar plate method. PP and PS N. gonorrhoeae isolates were susceptible to clinically achievable levels of all antibiotics tested. There were, however, marked differences among the drugs with regard to the concentration required to inhibit growth. The PP N. gonorrhoeae isolates were extremely susceptible to ceftriaxone, ceftizoxime, and cefotaxime, highly susceptible to moxalactam and cefoperazone, and less susceptible to cefoxitin, ceforanide, and cefonicid (geometric mean minimal inhibitory concentrations were 0.002, 0.003, 0.007, 0.03, 0.07, 0.6, 2.4, and 3.1 micrograms/ml, respectively). Although this in vitro study showed PP N. gonorrhoeae isolates to be comparatively more susceptible to ceftriaxone, ceftizoxime, and cefotaxime than to the other antibiotics, these results may not correlate with clinical efficacy.