bacampicillin and Gonorrhea

Sixty three patients presumed to have genital gonorrhoea who gave histories of extragenital sexual practices were randomly treated with amoxycillin 3 g or bacampicillin 4.8 g (equivalent to 3.5 g ampicillin) with probenecid 1 g to compare the efficacy of the drugs in treating gonorrhoea at all sites. Three patients were initially culture negative, and seven failed to return for follow up. Twenty seven of 28 patients receiving bacampicillin and all 25 receiving amoxycillin gave negative genital cultures for Neisseria gonorrhoeae five to nine days after treatment. Twenty two of 60 patients had extragenital gonorrhoea. One failed to return, but all eight who had received amoxycillin and 12 of 13 who had received bacampicillin gave negative pharyngeal and anorectal cultures after treatment. N meningitidis was isolated from the pharynx in 17 of 60 patients on initial attendance. Three of 14 were still colonised with the meningococcus after treatment. Two of 32 patients receiving amoxycillin and 12 of 31 receiving bacampicillin reported experiencing gastrointestinal side effects.

Topics: Amoxicillin; Ampicillin; Anus Diseases; Bacterial Infections; Drug Therapy, Combination; Female; Genital Diseases, Female; Genital Diseases, Male; Gonorrhea; Humans; Male; Neisseria meningitidis; Pharyngeal Diseases; Probenecid; Random Allocation; Rectal Diseases

Bacampicillin hydrochloride, a pro-drug ester of ampicillin trihydrate which is hydrolysed to ampicillin after absorption, was used in a randomised comparative study of ampicillin 3.5 g and bacampicillin 1.6g (each with probenecid 1 g) in the treatment of uncomplicated gonorrhoea. This dose of bacampicillin was selected because in serum it gives approximately the same peak concentration of ampicillin as 3.5 g of the present drug. Genital, pharyngeal, and anal cultures were performed at the initial visit and at follow up 5-9 days after treatment. There was no statistically significant difference in the microbiological or clinical response of patients with genital gonorrhoea who were treated with ampicilin and those treated with bacampicillin. At 5-9 days after treatment, 93% of the ampicillin-treated patients and 89% of the bacampicillin-treated patients had negative genital, pharyngeal, and anal culture results; furthermore, 87% and 89% respectively had no symptoms of infection. Fewer gastrointestinal side effects were noted in the patients treated with bacampicillin.

Topics: Adolescent; Adult; Ampicillin; Clinical Trials as Topic; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Penicillin Resistance; Random Allocation

Topics: Ampicillin; Clinical Trials as Topic; Dose-Response Relationship, Drug; Female; Gonorrhea; Humans; Male; Time Factors

During the three years 1981-3, 134 (9.1%) of 1473 patients presenting at our clinics were found to be infected with penicillinase producing strains of Neisseria gonorrhoeae (PPNG). Minimum inhibitory concentrations (MICs) of benzylpenicillin and ampicillin against these PPNG strains were 8 mg/l or more, whereas against non-PPNG strains they were consistently 4 mg/l or less. In contrast, the MIC of BRL25000 (two parts amoxycillin and one part clavulanic acid, the beta lactamase inhibitor) was 4 mg/l or less even against PPNG strains. MICs of a number of other drugs commonly used to treat gonorrhoea, such as cephaloridine, cefoxitin, tetracycline, doxycycline, minocycline, kanamycin, and spectinomycin, showed no appreciable differences between non-PPNG and PPNG strains and the MIC of cephaloridine in particular was relatively high. BRL25000 proved to be very effective in the treatment of PPNG infection and cured all of 121 patients treated. A daily dose of 2.25g, cured 105 patients in two days, 11 patients in three days, four patients in four days, and one patient in five days. A new rapid diagnostic method for detecting PPNG strains, capable of application at an outpatient clinic and providing a result on the following day, is described.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Clavulanic Acids; Drug Combinations; Female; Gonorrhea; Humans; Japan; Male; Neisseria gonorrhoeae; Penicillinase