cefotaxime and Gonorrhea

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Female; Gonorrhea; Humans; Japan; Male; Neisseria gonorrhoeae; Pharyngitis; Sexual Behavior; Sexually Transmitted Diseases

Topics: 4-Quinolones; Anti-Infective Agents; Cefotaxime; Diagnosis, Differential; Female; Gonorrhea; Humans; Male; Molecular Diagnostic Techniques; Neisseria gonorrhoeae; Pharyngitis; Prognosis; Urethritis; Uterine Cervicitis

Topics: Administration, Oral; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Cefixime; Cefotaxime; Gonorrhea; Humans; Penicillinase

Topics: Anti-Bacterial Agents; Azithromycin; Cefixime; Cefotaxime; Chlamydia Infections; Chlamydia trachomatis; Female; Gonorrhea; Humans; Male; Research Design; Sexually Transmitted Diseases, Bacterial

Topics: Administration, Oral; Anti-Infective Agents; Cefixime; Cefotaxime; Chlamydia Infections; Ciprofloxacin; Doxycycline; Female; Gonorrhea; Guidelines as Topic; Humans; Male; Ofloxacin; Randomized Controlled Trials as Topic

The microbiological, kinetic and clinical profile of cefixime, a IIIrd generation cephalosporin, administered orally, is presented. Cefixime is highly active versus Gram-negative aerobic bacteria while, with respect to Gram-positive bacteria, it is only active against Str. pneumoniae, Str. pyogenes, Str. agalactiae, and Str. bovis. It has no action against anaerobics. Endowed with good kinetics, cefixime possesses a favourable tissue distribution. Cefixime is highly indicated in infections of the upper and lower airways where the aethiology is prevalently due to Str. pneumoniae, H. influenzae and B. catarrhalis, that are extremely sensitive to the antibiotic. It is concluded that the therapeutic armamentarium has been enriched by a new, highly active antibiotic that, administered in a monodese/die, ca satisfy patient compliance.

Topics: Animals; Bacteria; Cefixime; Cefotaxime; Gonorrhea; Humans; Microbial Sensitivity Tests; Otitis Media; Pharyngitis; Respiratory Tract Infections; Tonsillitis; Urinary Tract Infections

Single drug therapy using a third generation cephalosporin of the cefotaxime type is possible in a number of situations where host defenses are intact, the causative microorganism is very sensitive (MIC less than 1 mg/l) and not concerned with phenomena of resistance by mutation, and the antibiotic is able to reach the site of infection at high concentrations. In contrast, the indications for two-drug therapy including an aminoglycoside appear to be better identified in patients with granulocytopenia. The possibility of single drug therapy preceded by a short period of two-drug therapy is also discussed.

Topics: Bacteria; Cefotaxime; Drug Therapy, Combination; Gonorrhea; Humans; Meningitis; Pneumonia, Pneumococcal; Urinary Tract Infections

A review is given of the selection and rational of optimal treatment regimens for patients with sexually transmitted pathogens, e.g. in cases of gonorrhea, chlamydial infections, chancroid, syphilis, pelvic inflammatory diseases and ophthalmia neonatorum. The scientific basis for the selection of a beta-lactam agent is discussed, including dose, MIC, the critical serum level and maintenance interval, and the duration of therapy. Except in the case of penicillinase-producing Neiserria gonorrhoeae, penicillin remained until recently the most effective agent available against many sexually transmitted diseases. However, ceftriaxone, a new third-generation cephalosporin, has been shown to have a long half-life (8 h) and excellent in vitro efficacy against Neiserria gonorrhoeae (including penicillinase-producing strains) and Haemophilis ducreyi. In view of its exceptional clinical efficacy against both gonorrhea and chancroid, clinical studies of its efficacy against other sexually transmitted diseases appear warranted.

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cephalosporins; Chancroid; Chlamydia Infections; Female; Gonorrhea; Humans; Infant, Newborn; Male; Ophthalmia Neonatorum; Pelvic Inflammatory Disease; Penicillins; Sexually Transmitted Diseases; Syphilis; Time Factors; Urethritis

Cefodizime (CDZM) has strong antimicrobial activity to Neisseria gonorrhoeae in vitro. However, multidrug-resistant N. gonorrhoea emerged and has been increasing in Japan. To know the effectiveness of CDZM on gonococcal urethritis and uterine cervicitis even in the era of multidrug-resistant N. gonorrhoeae, a clinical trial of single-dose therapy of CDZM for gonococcal urethritis and uterine cervicitis was conducted. N. gonorrhoeae was eradicated from 100% of patients with gonococcal urethritis and uterine cervicitis by a single dose of CDZM. In conclusion, CDZM is one of most suitable drugs for the treatment of gonococcal genital infection in the era of multidrug-resistant N. gonorrhoeae.

Topics: Anti-Bacterial Agents; Cefotaxime; Drug Resistance, Multiple, Bacterial; Female; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Urethritis; Uterine Cervicitis

In a randomized open study, 351 male patients with uncomplicated gonorrhea were given single oral doses of grepafloxacin (400 mg) or cefixime (400 mg). In the 299 microbiologically evaluable patients, urethral infections were cured in 99% (147 of 149) of those receiving grepafloxacin and 97% (145 of 150) of those given cefixime. Eradication rates for both regimens were 100% in the 16% (47 of 299) of participants who were infected with penicillin-resistant Neisseria gonorrhoeae and 97% in the 21% (62 of 299) of participants infected with tetracycline-resistant strains. Grepafloxacin is a well-tolerated alternative to cefixime for treatment of uncomplicated gonorrhea in males.

Topics: Administration, Oral; Adolescent; Anti-Infective Agents; beta-Lactam Resistance; Cefixime; Cefotaxime; Cephalosporins; Fluoroquinolones; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin Resistance; Piperazines; Quinolones

Cefotaxime is a third-generation cephalosporin with excellent in vitro antimicrobial activity against Neisseria gonorrhoeae, including beta-lactamase-producing strains. A single 1-g intramuscular dose is suitable for the treatment of uncomplicated gonorrhea. We conducted an open, randomized study to evaluate the efficacy, safety, and cost impact of a lower dose (500 mg) of cefotaxime versus 250 mg ceftriaxone, an often recommended treatment for uncomplicated gonorrhea. Of the 222 patients enrolled, the cases of 151 were fully assessable. Bacteriologic elimination rates were 99% in the cefotaxime group and 100% in the ceftriaxone group. Clinical response rates were 78% and 83% in the two groups, respectively. Adverse clinical events occurred in 4% and 9% of patients in the two groups, respectively. The average wholesale price of 500 mg cefotaxime is 31% lower than that of 250 mg ceftriaxone. A 500-mg dose of cefotaxime appears to be a safe and cost-effective alternative to 250 mg ceftriaxone for the treatment of uncomplicated gonorrhea.

Topics: Adolescent; Adult; Cefotaxime; Ceftriaxone; Costs and Cost Analysis; Drug Resistance, Microbial; Female; Gonorrhea; Humans; Injections, Intramuscular; Male; Neisseria gonorrhoeae; Rectal Diseases; Urethral Diseases; Uterine Cervicitis

Sexually transmitted diseases (STDs) have a significant adverse effect on reproductive and child health worldwide. The control of STDs such as gonorrhea is therefore an absolute priority. Cefixime, an oral third-generation cephalosporin with in vitro activity similar to that of ceftriaxone, may be an effective candidate for the treatment of gonorrhea. The efficacy of a single oral 400-mg dose of cefixime was compared with that of a single intramuscular 250-mg dose of ceftriaxone for the treatment of Neisseria gonorrhoeae urethritis in 190 men and cervicitis in 46 women in Nairobi, Kenya. A bacteriologic cure was recorded in 100% of 63 evaluatable patients treated with ceftriaxone and 118 (98%) of 121 evaluatable patients treated with cefixime. Cefixime, as a single oral dose, is an effective alternative for the treatment of uncomplicated gonococcal urethritis in men and cervicitis in women.

Topics: Administration, Oral; Adult; Aged; Anti-Bacterial Agents; Cefixime; Cefotaxime; Ceftriaxone; Drug Evaluation; Female; Gonorrhea; Humans; Injections, Intramuscular; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Urethritis; Uterine Cervicitis

Topics: Anti-Infective Agents, Urinary; Cefixime; Cefotaxime; Ceftriaxone; Female; Gonorrhea; Humans; Male

A placebo-controlled prospective randomised double-blind study was performed in 80 consecutive female outpatients with acute cystitis. Single dose oral antibiotic treatment was successful in 89.4% of patients treated with cefixime 400mg or ofloxacin 200mg and in 84.2% of those receiving cotrimoxazole (160/800mg). Bacteriuria was eradicated in 26.3% of patients in the placebo group. Two noncomparative clinical trials involving a total of 43 male patients with acute gonococcal urethritis reported a 100% cure rate after administration of a single 400mg dose of cefixime. Such single dose regimens offer the advantages of reduced expense, good tolerability, minimal alteration of normal bacterial flora, and the potential for improved patient compliance, compared with multiple dose antibacterial therapy.

Topics: Acute Disease; Administration, Oral; Cefixime; Cefotaxime; Cystitis; Double-Blind Method; Female; Gonorrhea; Humans; Male; Urethritis

Because of the widespread existence of Neisseria gonorrhoeae resistant to penicillin or tetracycline, ceftriaxone is now recommended for the treatment of gonorrhea. There is, however, a need for effective antibiotics that can be administered orally as an alternative to ceftriaxone, which requires intramuscular administration. Cefixime is an orally absorbed cephalosporin that is active against resistant gonococci and has pharmacokinetic activity suitable for single-dose administration.. In a randomized, unblinded multicenter study of 209 men and 124 women with uncomplicated gonorrhea, we compared three single-dose treatment regimens: 400 mg or 800 mg of cefixime, administered orally, and 250 mg of ceftriaxone administered intramuscularly. The overall cure rates were 96 percent for the 400-mg dose of cefixime (89 of 93 patients) (95 percent confidence interval, 93.5 percent to 97.8 percent); 98 percent for the 800-mg dose of cefixime (86 of 88 patients) (95 percent confidence interval, 94.6 percent to 100 percent); and 98 percent for ceftriaxone (92 of 94 patients) (95 percent confidence interval, 94.9 to 100 percent). The cure rates were similar in men and women, and pharyngeal infection was eradicated in 20 of 22 patients (91 percent). Thirty-nine percent of 303 pretreatment gonococcal isolates had one or more types of antimicrobial resistance; the efficacy of all three regimens was independent of the resistance pattern. Chlamydia trachomatis infection persisted in at least half the patients infected in each treatment group. All three regimens were well tolerated.. In the treatment of uncomplicated gonorrhea, a single dose of cefixime (400 or 800 mg) given orally appears to be as effective as the currently recommended regimen of ceftriaxone (250 mg given intramuscularly).

Topics: Administration, Oral; Adolescent; Adult; Cefixime; Cefotaxime; Ceftriaxone; Drug Resistance, Microbial; Drug Tolerance; Female; Gonorrhea; Humans; Injections, Intramuscular; Male

In this randomized study, a single 800-mg oral dose of cefixime cured 96 of 97 men with uncomplicated gonococcal urethritis, compared with 44 cures of 46 men who received standard therapy with amoxicillin (3 g) plus probenecid (1 g). Both regimens were ineffective against coexistent infection with Chlamydia trachomatis and Ureaplasma urealyticum. Cefixime was well tolerated, and all side effects were mild and self-limited.

Topics: Adolescent; Adult; Amoxicillin; Cefixime; Cefotaxime; Gonorrhea; Humans; Male; Probenecid; Randomized Controlled Trials as Topic; Urethritis

The highest minimum inhibitory concentrations of ceftriaxone and cefotaxime in 89 analysed Neisseria gonorrhoeae isolates amounted to 0.008 and 0.031 micrograms/ml, respectively. In a randomized controlled trial the single intramuscular injection of ceftriaxone 250 mg and cefotaxime 500 mg cured bacteriologically 35 out of 35, and 29 out of 30 patients, respectively, with uncomplicated gonorrhoea. Facing the different phenotypes of the isolates grown before and after therapy in the case of the non-cured patient within the cefotaxime treatment group, reinfection rather than failure has to be presumed. Postgonococcal urethritis occurred about as often in both groups, the percentage amounting to 24.2 and 28.6%, respectively. If side effects were noted at all, they were considered minor: 4 patients belonging to the first and 3 belonging to the second treatment group complained temporarily about pain at the injection site. Due to the data presented here, ceftriaxone and cefotaxime appear equally effective and safe when used in the dose generally preferred, irrespective of differences in in vitro activity and pharmacokinetic behaviour.

Topics: Adult; Cefotaxime; Ceftriaxone; Drug Administration Schedule; Drug Resistance, Microbial; Female; Gonorrhea; Half-Life; Humans; Injections, Intramuscular; Male; Middle Aged; Neisseria gonorrhoeae; Random Allocation

Uncomplicated urogenital and concomitant oropharyngeal gonorrhea in 424 male and female patients was treated in a randomized comparative study with 0.5 g of cefodizime (89 men and 54 women), 1 g of cefodizime (87 men and 52 women), or 1 g of cefotaxime (86 men and 56 women). The cure rates were 100% for men and women in the group given 0.5 g of cefodizime, 100% for men and women in the group given 1 g of cefodizime, and 99% for men and 100% for women in the group given 1 g of cefotaxime. The MICs of cefodizime and cefotaxime for the isolate of Neisseria gonorrhoeae ranged from 0.004 to 0.06 micrograms/ml. Chlamydia trachomatis was isolated before treatment in 15% and after treatment in 13% of all patients. Side effects, such as nausea, diarrhea, abdominal pain, genital candidiasis, and pain at the site of injection, developed in 4% of the patients given cefodizime. Side effects, such as vertigo, genital candidiasis, fatigability, and diarrhea, developed in 4% of the patients treated with cefotaxime. In both groups of patients, the side effects were mild and transient. Cefodizime and cefotaxime are safe and effective agents in the treatment of uncomplicated urogenital gonorrhea.

Topics: Cefotaxime; Chlamydia trachomatis; Drug Evaluation; Female; Gonorrhea; Humans; Injections, Intramuscular; Male; Random Allocation

Since being recognized in 1976 and 1983, respectively, penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) and chromosomally mediated resistance (CMRNG) have attained a worldwide distribution. The high endemicity of both types of resistance in some regions precludes the continued routine use of procaine penicillin (APPG) as treatment for gonorrhea. In this study, we have evaluated 72/216 men with uncomplicated gonococcal urethritis at the venereal clinic in Mexico City. These men were part of a blinded randomized comparative study for treatment with group (P) penicillin having 33 patients and group (S) spectinomycin having 39. Efficacy with (P) was 24/33 (72.7%); nine failures retreated and were cured with spectinomycin. Efficacy with (S) was 35/39 (89.7%); four failures retreated and were cured with cefotaxime. We found correlation between MICs and resistance; all the strains with MICs of greater than or equal to 1.0 mcg/ml of penicillin failed to be cured, the MICs of greater than or equal to 32 mcg/ml of spectinomycin failed to be cured. The overall resistance to both regimens was 23/72 to penicillin (31.9%) (22 PPNG and one CMRNG) and 4/72 (5.5%) to spectinomycin.

Topics: Adolescent; Adult; Cefotaxime; Drug Resistance, Microbial; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Penicillin G; Penicillin G Procaine; Probenecid; Random Allocation; Spectinomycin; Urethritis

C-reactive protein (CRP), a biological marker of inflammation, may be a useful indicator of therapeutic response in patients with septic pelvis. In a study comparing ceftizoxime and cefoxitin/doxycycline in patients with septic pelvis, quantitative CRP levels were closely correlated with the responses and failures of therapy. The results of this study showed the two antibiotic regimens to be equally effective, with 23 of 25 patients in each treatment group achieving a satisfactory response. The fact that ceftizoxime was effective in four of five patients with Chlamydia trachomatis in cervical isolates suggests that intravenous therapy for the acute infection can be accomplished without the addition of an antichlamydial agent. Upon discharge from the hospital, patients can continue therapy with an oral drug that is specifically active against Chlamydia.

Topics: C-Reactive Protein; Cefotaxime; Cefoxitin; Ceftizoxime; Chlamydia Infections; Doxycycline; Drug Combinations; Female; Gonorrhea; Humans; Injections, Intravenous; Random Allocation; Salpingitis

Cefotetan is a newly developed cephamycin especially resistant to bacterial beta-lactamase. Therefore both its in vitro activity against Neisseria gonorrhoeae and its clinical efficacy in uncomplicated gonorrhea are investigated. The minimal inhibitory concentrations (MIC) lie in the range of 0.016-2 micrograms/ml, 90% of the strains being inhibited by 0.5 microgram/ml. Of 52 finally evaluable patients who were treated by a single intramuscular injection of 1 g, 48 (92.3%) were cured bacteriologically. Thus the present treatment protocol may prove useful in individual cases. It should, however, not be advocated for gonorrhea treatment in general.

Topics: Adult; Cefotaxime; Cefotetan; Ceftizoxime; Cephamycins; Clinical Trials as Topic; Female; Gonorrhea; Humans; Injections, Intramuscular; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin G

Of the currently recommended regimens for treatment of uncomplicated gonorrhea, only aqueous penicillin G procaine is effective against infections at all sites. However, procaine penicillin is not effective against penicillinase-producing Neisseria gonorrhoeae and suffers from poor patient acceptability owing to the 10-mL volume of injection and allergic and toxic procaine reactions. Ceftriaxone is a new extended-spectrum cephalosporin with a long serum half-life and is many times more active than penicillin G against both beta-lactamase-positive or -negative strains of N gonorrhoeae. Ceftriaxone was compared as a single, 125-mg, 0.5-mL injection with a single 2-g injection of spectinomycin in difficult to treat pharyngeal gonorrhea in men and women and anorectal gonorrhea of men. Ceftriaxone cured 30/32 (94%) pharyngeal and 52/52 anorectal infections, compared with 6/14 (43%) and 9/9, respectively, for spectinomycin. Both regimens were well tolerated. Ceftriaxone may prove to be a drug of choice for uncomplicated gonorrhea, particularly where homosexual men are treated and/or penicillinase-producing N gonorrhoeae is prevalent.

Topics: Adult; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Drug Eruptions; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Penicillin G; Pharyngitis; Proctitis; Spectinomycin; Tetracycline

From 26 April to 30 June 1983 a total of 200 men with uncomplicated gonococcal urethritis were randomly treated with either 2 g spectinomycin or 250 mg ceftriaxone, both administered intramuscularly. Of 197 isolates tested for the presence of the enzyme beta lactamase, 91 (46.2%) were positive (PPNG) and 106 (53.8%) were non-PPNG strains. All 93 patients treated with spectinomycin and followed up and 97 treated with ceftriaxone and followed up were cured. Ceftriaxone 250 mg administered by intramuscular injection is highly effective in treating gonococcal infections caused by both PPNG and non-PPNG strains and is an appropriate alternative to spectinomycin.

Topics: Cefotaxime; Ceftriaxone; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillinase; Spectinomycin; Urethritis

Single-dose ceftriaxone, 125 mg given intramuscularly, was compared with spectinomycin 2.0 g given intramuscularly in the treatment of women with uncomplicated gonorrhea. Cervical or anorectal gonococcal infection was eradicated in 54 (98 percent) of 55 women treated with ceftriaxone and 22 (96 percent) of 23 treated with spectinomycin. Cure rates for pharyngeal gonococcal infections were nine of 10 for ceftriaxone and four of eight for spectinomycin (p = 0.18). Neither agent eradicated concurrent Chlamydia trachomatis infection. The geometric mean minimal inhibitory concentration for ceftriaxone was 0.0038 microgram/ml for 65 pretreatment cervical isolates of beta-lactamase-negative Neisseria gonorrhoeae and all isolates were inhibited by 0.063 microgram/ml. Neither drug caused perceptible toxicity, but patient acceptance was better for ceftriaxone than for spectinomycin. A single 125 mg dose of ceftriaxone is an excellent regimen in the treatment of uncomplicated gonorrhea in women.

Topics: Adolescent; Adult; Cefotaxime; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; Female; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Spectinomycin

The clinical and bacteriologic efficacy of ceftriaxone given once or twice daily was evaluated in 153 studies. A total of 2,635 patients received ceftriaxone given intramuscularly or intravenously, 930 received comparative antibiotics, and 81 received placebo. For the 10 major categories of infections treated (central nervous system, upper and lower respiratory tract, intraabdominal, skin and skin structure, bone and joint, urinary tract, gynecologic, and bacterial sepsis), the clinical response rates were 89 percent or greater. Bacteriologic cure rates were 84 percent or greater overall and 90 percent or greater for seven of 10 categories. Ceftriaxone achieved a satisfactory clinical response (cure or improvement) for 89 (intraabdominal) to 99 percent (urinary tract) of the infections treated. Additionally, pediatric central nervous system infections responded to twice-daily ceftriaxone injection; ceftriaxone, in a single dose as low as 250 mg, cured gonorrhea, and a single dose of ceftriaxone was as effective as multiple doses of cefazolin in surgical prophylaxis.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Male; Middle Aged; Premedication

In an open randomized study in a large Rotterdam male and female population (n = 1500), suffering from uncomplicated urogenital, rectal and oropharyngeal gonorrhoea treatment with cefotaxime 1.0 g proved to be more effective than with cefuroxime 1.5 g in all patients studied. However, statistically significant differences between the failure rates of the cefotaxime and the cefuroxime treatment were found only for all male and female patients, in urethral or urogenital and rectal infections in this group, for all male patients, and in urethral infections in men. Failure rates were low (1.7 and 5.6%, respectively for cefotaxime and cefuroxime). Oropharygeal gonorrhoea responded less well than urethral or urogenital and rectal gonorrhoea. Both drugs were very effective in the eradication of uncomplicated gonococcal infections caused by both non-beta-lactamase producing and beta-lactamase producing gonococci. High (greater than 30%) post-gonococcal urethritis rates were observed. Side-effects were minor.

Topics: beta-Lactamases; Cefotaxime; Cefuroxime; Cephalosporins; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Pharyngeal Diseases; Random Allocation; Rectal Diseases; Urethral Diseases; Uterine Cervical Diseases

Topics: Cefotaxime; Ceftriaxone; Female; Gonorrhea; Humans; Male; Neisseria meningitidis; Pharynx; Pilot Projects

Single-dose ceftriaxone, 125 mg or 250 mg intramuscularly (IM), was compared with spectinomycin, 2 g IM, for treatment of men with uncomplicated urethral or anorectal infections due to penicillinase-negative Neisseria gonorrhoeae. Cure rates were 100% for 31 and 28 men treated with 125 mg and 250 mg ceftriaxone, respectively, and 97% for 58 men given spectinomycin. Among patients followed up for greater than or equal to 14 days, post-gonococcal urethritis occurred in 25% of 44 men treated with ceftriaxone and 19% of 47 given spectinomycin (p = NS). The geometric mean minimum inhibitory concentration of ceftriaxone for 79 pre-treatment isolates of N gonorrhoeae was 0.0058 microgram/ml, and all strains were inhibited by less than or equal to 0.063 micrograms/ml. Neither drug caused perceptible toxicity, but patient acceptance was greater for ceftriaxone than for spectinomycin. Ceftriaxone in a single dose of 125 mg is effective against uncomplicated urethral or anorectal gonorrhoea in men and may become a regimen of choice for this infection.

Topics: Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Drug Resistance, Microbial; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Pharyngeal Diseases; Random Allocation; Spectinomycin

Uncomplicated gonorrhea of 122 mucosal sites in 51 women was successfully treated with either a single intramuscular dose of 250 mg of ceftriaxone (23 patients) or two intramuscular doses of 4.8 X 10(6) U of aqueous procaine penicillin G (28 patients). Women treated with ceftriaxone had 22 cervical, 12 urethral, 10 anal canal, and 5 pharyngeal infections. All 122 pretreatment isolates were inhibited by 0.0125 microgram or less of ceftriaxone per ml. The minimal concentration needed to inhibit 90% of isolates was 0.006 microgram/ml for ceftriaxone and 0.2 microgram/ml for penicillin G. Ceftriaxone was very well tolerated and caused no toxicity.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Female; Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillin G Procaine

A total of 121 men with complicated infections caused by beta-lactamase-negative Neisseria gonorrhoeae were included in this study. They were randomly assigned to regimens of either cefmenoxime (1.0 g) or procaine penicillin G (4.8 X 10(6) U) intramuscularly. Only the penicillin group also took 1.0 g of probenecid orally. A total of 99 patients completed the study, providing data from 108 infected sites. In the cefmenoxime group, there were 49 urethral, 1 rectal, and 2 pharyngeal infections; in the penicillin group, there were 49 urethral, 4 rectal, and 3 pharyngeal infections. In the cefmenoxime group, all except one urethral infection were eradicated. This patient admitted having had sexual intercourse during the follow-up period and was considered to be reinfected. In the penicillin group, all except one pharyngeal infection were cured. No adverse reactions were noted in either group. In this study, cefmenoxime was as effective as penicillin in the treatment of gonococcal urethritis in men.

Topics: Anti-Bacterial Agents; Cefmenoxime; Cefotaxime; Gonorrhea; Humans; Male; Penicillins

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.

Topics: Cefotaxime; Cefoxitin; Ceftriaxone; Gonorrhea; Humans; Male; Penicillin Resistance; Random Allocation; Urethritis

Ceftriaxone, a third generation cephalosporin, was used in a single intramuscular dose with oral probenecid to treat 124 men with infections due to non-penicillinase-producing Neisseria gonorrhoeae (non-PPNG) and 64 men with infections due to PPNG. Three different doses of ceftriaxone were used--125 mg, 62.5 mg, ad 32.5 mg, and 32.5. The cure rate for all PPNG infections with the different doses was 100%. The cure rate for the non-PPNG infections with ceftriaxone 125 mg was 100%; those for non-PPNG infections treated with ceftriaxone 62.5 mg and 32.5 mg were 96.2% and 97.3% respectively. The 160 strains of non-PPNG and 60 strains of PPNG isolated were all susceptible to ceftriaxone with minimum inhibitory concentrations of 0.008 microgram/ml. These results are compared with those using kanamycin 2 g. Ceftriaxone is a safe and effective treatment for PPNG and non-PPNG infections.

Topics: Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Gonorrhea; Humans; Kanamycin; Male; Neisseria gonorrhoeae; Penicillinase; Probenecid; Urethritis

Topics: Cefotaxime; Ceftizoxime; Drug Therapy, Combination; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G Procaine; Probenecid

Topics: Adolescent; Adult; Cefotaxime; Ceftizoxime; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Penicillin G Procaine; Probenecid

Topics: Abdomen; Arthritis, Infectious; Bacterial Infections; Cefotaxime; Ceftizoxime; Clinical Trials as Topic; Gonorrhea; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meningitis; Osteitis; Respiratory Tract Infections; Sepsis; Skin Diseases, Infectious; United States; Urinary Tract Infections

More and more beta-lactamase-producing, penicillin-resistant strains of Neisseria gonorrhoeae are nowadays isolated in most parts of the world including the European continent. Therefore, there is a need for reliable alternatives in the treatment of gonorrhoea. Cefotaxime--first representative of a new generation of beta-lactamase-resistant cephalosporins--was evaluated for this reason, first in vitro and then in vivo. All 191 strains tested proved susceptible, the highest MIC amounting to 0.03 microgram/ml, a drug concentration well exceeded in plasma for more than 4 h after i.m. application of 0.5 g cefotaxime. In contrast to other investigators we have therefore decided to test this relatively small dose clinically without the addition of probenecid. The clinical results were excellent: 146 of 151 patients (96.7%) were cured. In the female sub-group (34 patients) the cure rate amounted to 100%. Thus, the i.m. injection of 0.5 g cefotaxime as a single dose must be looked upon as a reliable regimen for the cure of uncomplicated gonorrhoea, both in males and females.

Topics: Cefotaxime; Clinical Trials as Topic; Culture Techniques; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G; Penicillin Resistance

Ninety-seven patients with 118 sites infected with Neisseria gonorrhoeae were treated with a single dose of either procaine penicillin G (4.8 x 10(6) U) or cefotoxime (1.0 g) intramuscularly. Only the penicillin group took 1 g of probenecid orally. The numbers of infected sites in each treatment group were as follows: penicillin-urethra, 37; rectum, 9; cervix, 8; and pharynx, 4; cefotaxime-urethra, 42; rectum, 9; cervix, 5; and pharynx, 4. The cure rates in each treatment group were 100%. No adverse reactions were noted in either group. beta-Lactamase-positive N. gonorrhoeae strains were not found. Ninety-five percent of clinical isolates were inhibited by less than or equal to 0.007 micrograms of cefotaxime and less than or equal to 0.25 micrograms of penicillin per ml. In this study cefotaxime was as effective as procaine penicillin in the treatment of uncomplicated gonorrhea.

Topics: Cefotaxime; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G Procaine; Penicillin Resistance

Uncomplicated gonorrhea in men was successfully treated with ceftriaxone in single intramuscular doses of 125 mg (15 patients), 250 mg (16 patients), or 500 mg (15 patients). All 45 pretreatment gonococcal isolates tested were inhibited by

Topics: Adolescent; Adult; Cefotaxime; Ceftriaxone; Drug Evaluation; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae

Sexually transmitted infections (STI) caused by multidrug resistant Neisseria gonorrhoea are an emerging threat to global health. In the Netherlands, the general practitioner (GP) provides the major part of STI care. In 2013 an update of the Dutch guideline was published, recommending a single dose of intramuscular ceftriaxone as treatment for gonorrhoea infections. Data from a Dutch General Practitioner research database was used to investigate the guideline implementation for the treatment of gonorrhoea. A survey was conducted to gain more insight in GPs experiences with the recommended intramuscular therapy.. Data on STI-related episodes and STI-diagnoses for gonorrhoea, based on ICPC codes were obtained from the electronic medical records (EMRs) from 35 GPs in Amsterdam for the years 2010 to 2016. Questionnaires regarding the treatment preferences were sent to GPs participating in the research network database.. The number of gonorrhoea cases treated with first choice therapy increased from 81% in 2010 (intramuscular cefotaxime or ceftriaxone) to 93% in 2015 (only cefttriaxone). The number of ceftriaxone prescriptions increased substantially from 30% in 2010 to 93% in 2015. GPs preferred a single intramuscular shot of a third-generation cephalosporin above multiple oral doses of other antibiotics.. The results demonstrate a successful shift in the antimicrobial management of gonorrhoea infections to ceftriaxone monotherapy according to the national guideline. GPs in this higher prevalence area in Amsterdam reported limited barriers in the intramuscular administration of third-generation cephalosporins.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cross-Sectional Studies; Female; General Practitioners; Gonorrhea; Humans; Injections, Intramuscular; Male; Netherlands; Practice Patterns, Physicians'; Young Adult

We describe the first case of treatment failure of gonorrhoea with a third generation cephalosporin, cefotaxime 1g intramuscularly, in the Netherlands. The case was from a high-frequency transmitting population (men having sex with men) and was caused by the internationally spreading multidrug-resistant gonococcal NG-MAST ST1407 clone. The patient was clinically cured after treatment with ceftriaxone 500 mg intramuscularly and this is the only third generation cephalosporin that should be used for first-line empiric treatment of gonorrhoea. Increased awareness of failures with third generation cephalosporins, enhanced monitoring and appropriate verification of treatment failures including more frequent test-of-cures, and strict adherence to regularly updated treatment guidelines are essential globally.

Topics: Adult; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Drug Resistance, Multiple, Bacterial; Gonorrhea; Homosexuality, Male; Humans; Injections, Intramuscular; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Netherlands; Treatment Failure

Topics: Adult; Anti-Bacterial Agents; Cefotaxime; Female; Gonorrhea; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Neisseria gonorrhoeae; Pneumonia, Bacterial; Pregnancy; Premature Birth

From 2006 to 2008, Neisseria gonorrhoeae isolates were identified with decreased susceptibility to the extended-spectrum cephalosporin (ESC) cefotaxime among visitors of the Amsterdam sexually transmitted infections (STI) clinic, the Netherlands. Spread, clonality, and characteristics of 202 isolates were examined using antibiograms, conventional penA mosaic gene PCR, and N. gonorrhoeae multiple-locus variable-number tandem repeat analysis (NG-MLVA). A strictly defined subset was further characterized by N. gonorrhoeae multiantigen sequence typing (NG-MAST) and sequencing of ESC resistance determinants (penA, mtrR, and porB1b). Seventy-four N. gonorrhoeae isolates with a cefotaxime MIC of >0.125 μg/ml (group A), 54 with a cefotaxime MIC of 0.125 μg/ml (group B), and a control group of 74 with a cefotaxime MIC of <0.125 μg/ml (group C) were included. Fifty-three clonally related penA mosaic-positive isolates (penicillin-binding protein 2 type XXXIV) were identified in group A (n = 47 isolates; 64%) and B (n = 6 isolates; 11%). The 53 penA mosaic-positive isolates were predominantly NG-MAST ST1407 (87%) and contained an mtrR promoter A deletion (98%) and porB1b alterations G101K/A102N. All were assigned to the same NG-MLVA cluster that comprised in total 56 isolates. A correlation was found between decreased cefotaxime susceptibility and ST1407 that was highly prevalent among visitors of the Amsterdam STI clinic. The rapid spread of this strain, which also has been identified in many other countries, might be facilitated by high-risk sexual behavior and should be monitored closely to identify potential treatment failure. Quality-assured surveillance of ESC susceptibility on the national and international levels and exploration of new drugs and/or strategies for treatment of gonorrhea are crucial.

Topics: Adult; Alleles; Amino Acid Substitution; Anti-Bacterial Agents; Cefotaxime; Cephalosporin Resistance; Clone Cells; Female; Gonorrhea; Humans; Longitudinal Studies; Male; Microbial Sensitivity Tests; Mosaicism; Multilocus Sequence Typing; Neisseria gonorrhoeae; Netherlands; Phylogeny; Sequence Analysis, DNA

Infections caused by quinolone-resistant Neisseria gonorrhoeae are increasing worldwide. Although mostly mild and uncomplicated, serious infections causing severe morbidity are occasionally observed. We report 2 cases of sexually transmitted keratoconjunctivitis in adults resulting in severe visual disturbance.

Topics: Adult; Anti-Bacterial Agents; Cefotaxime; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Fluoroquinolones; Gonorrhea; Humans; Keratoconjunctivitis; Male; Middle Aged; Neisseria gonorrhoeae; Treatment Outcome

To ascertain recommendations for the treatment of gonorrhoea in the WHO Western Pacific Region (WPR) following the emergence of "cephalosporin-resistant" Neisseria gonorrhoeae and to relate these to clinical and laboratory measures directed towards disease and antibiotic resistance control. WHO WPR Gonococcal Antimicrobial Resistance Programme members provided data on the type, dose and source of third-generation cephalosporins recommended for the treatment of gonorrhoea. Ceftriaxone was recommended more widely (11/15 respondents) than cefixime (five centres). No cephalosporins were recommended in three jurisdictions. One other oral (ceftibuten) and injectable (cefodizime) agent was recommended. Uniform (400 mg) doses of cefixime were recommended but ceftriaxone regimens ranged between 125 mg and 1 g, with nine of 11 respondents using a 250 mg dose. Both generic and proprietary preparations were widely used. Third-generation cephalosporins are widely recommended for the treatment of gonorrhoea in the WPR, with injectable ceftriaxone more extensively so than oral cefixime and in an expanded dose range. Few other cephalosporins were recommended. Current knowledge suggests that the trend towards ceftriaxone treatment in higher doses may decrease the impact of the circulation of "cephalosporin-resistant" gonococci in the WPR. These recommendations represent public sector practice only and of themselves are unlikely to contain the further spread of "cephalosporin-resistant" gonococci because of the general clinical use of cephalosporins. Optimisation of strategies for laboratory detection of third-generation cephalosporin resistance can be simplified in the WPR because of the restricted spectrum of cephalosporins recommended. Additional efforts are urgently required for both disease and antibiotic resistance control in gonorrhoea.

Topics: Anti-Bacterial Agents; Asia, Southeastern; Australia; Cefixime; Cefotaxime; Ceftriaxone; Cephalosporin Resistance; Cephalosporins; Dose-Response Relationship, Drug; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Pacific Islands; Treatment Failure; World Health Organization

A single dose of cefodizime (CDZM), ceftriaxone (CTRX), or spectinomycin (SPCM) is recommended for the treatment of gonococcal urethritis or uterine cervicitis in the era of multidrug-resistant Neisseria gonorrhoeae; namely, cefozopran-resistant N. gonorrhoeae (CZRNG). N. gonorrhoeae pharyngeal infection is not so rare in Japan; however, the proper treatment regimen for this infection is not clear. We previously found that a single dose of CDZM completely eradicated multidrug-resistant N. gonorrhoeae in patients with urethritis and uterine cervicitis, so we tried a single 1.0-g dose of CDZM for the treatment of N. gonorrhoeae pharyngeal infection, including infections with CZRNG. The eradication rate of N. gonorrhoeae from the pharynx was 63.0% with a single 1.0-g dose of CDZM, while the rate for CZRNG with the same dose of CDZM was 38.5%. N. gonorrhoeae was completely eradicated from the pharynx when patients received one or two additional doses of CDZM. Therefore, we concluded that two to three doses of CDZM were necessary for the treatment of N. gonorrhoeae pharyngeal infection including infection with CZRNG.

Topics: Anti-Bacterial Agents; Cefotaxime; Drug Resistance; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Pharyngeal Diseases

To report the incidence of gonorrhoea and the development of resistance to Neisseria gonorrhoeae among attendees at the Municipal Health Service's STD-clinic in Amsterdam, The Netherlands, 2000-2003.. Descriptive.. Urethral or cervical swabs for culture for N. gonorrhoea were taken from attendees at the STD-clinic. Depending on reported sexual techniques throat and rectal swabs were also taken. The disk diffusion technique in combination with a beta-lactamase test were used for sensitivity testing. RESULTS. The number of Neisseria gonorrhoeae (NG) isolates collected at the Amsterdam Municipal Health Service's STD-clinic decreased from 1047 in 2002 to 772 in 2003. The number of fluoroquinolone-resistant NG (FRNG) isolates rose from 3 in 2000 to 56 in 2003 (p < 0.001). FRNG isolates amongst men who have sex with men increased from 1 in 568 isolates (0.2%) in 2000 to 50 in 478 isolates (10.5%) in 2003 (p < 0.001). Amongst heterosexual men, FRNG rose from 2 per 275 (0.7%) in 2000 to 16 per 297 (5.4%) in 2002 and dropped to 6 per 190 (3.4%) in 2003 (p = 0.146). No FRNG isolates were found in women in 2003 (2000: 0/180 (0.0%); 2001: 2/160 (1.3%); 2002: 4/183 (2.2%).. The recent incidence of FRNG among men who have sex with men to over 5% makes ciprofloxacin and other fluoroquinolones obsolete as the first-choice treatment option for uncomplicated gonorrhoea if no antibiogram is available. It is advised to use cefotaxim when an antibiogram is not available (yet).

Topics: Anti-Bacterial Agents; Cefotaxime; Drug Resistance, Bacterial; Female; Fluoroquinolones; Gonorrhea; Homosexuality, Male; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Netherlands; Risk Factors; Sexual Behavior

Topics: Adult; Bacteremia; Cefotaxime; Cephalosporins; Female; Gonorrhea; Humans; Infant, Newborn; Neisseria gonorrhoeae; Pregnancy; Pregnancy Complications, Infectious; Synovitis; Treatment Outcome

We compared the cost-effectiveness of two single-dose treatment strategies for adolescents with uncomplicated Neisseria gonorrhoeae cervicitis.. We used a cost-effectiveness decision- analysis model to compare the two methods: the standard, ceftriaxone 125 mg given by IM injection; and an alternative, cefixime 400 mg given orally. The effect of the costs associated with the risk of accidental needlestick during IM administration was also evaluated. Key baseline assumptions (with ranges, when tested) were from the literature or costs to our hospital. These included ceftriaxone, $8.60 per dose; cefixime, $4.67 per dose; ceftriaxone efficacy, 98% (range, 94.9% to 100%); cefixime efficacy, 97% (94.1% to 100%); and a 15% probability of pelvic inflammatory disease (PID) related to failed treatment. We included costs for PID necessitating hospitalization, disseminated gonococcal infection, infertility, and ectopic pregnancy. Assumptions related to accidental needlestick included the rate of needlesticks with the disposable syringe, 6.9 per 100,000 injections (range, 0 to 69); cost of accidental needlestick to hospital; risk of HIV seroconversion after needlestick exposure to HIV-infected blood, .36% (range, 0% to .86%); rate of HIV infection in 15- to 19-year-olds attending sexually transmitted diseases clinics, .4% (range, 0 to 5); and lifetime treatment costs for a person with HIV.. At baseline values the model favored ceftriaxone ($45 per patient) or cefixime ($59 per patient). However, over the range of efficacy of both drugs, two-way sensitivity analysis revealed no consistent cost advantage for either drug. The model was also insensitive to the economic effects associated with the risk of accidental needlestick during IM injection.. over the range of efficacy by the 95% confidence intervals of both drugs, our analysis demonstrated no clear cost advantage for either. The economic effects of accidental needlestick do not change this conclusion. Compared with the IM alternative, oral cefixime is painless to the patient and simpler for the practitioner to administer. Oral cefixime also eliminates the psychologic effects associated with needlesticks in health care workers. For these reasons, we favor the use of oral cefixime for uncomplicated gonococcal cervicitis in adolescents.

Topics: Administration, Oral; Adolescent; Anti-Infective Agents; Cefixime; Cefotaxime; Ceftriaxone; Cephalosporins; Cost of Illness; Cost-Benefit Analysis; Decision Support Techniques; Decision Trees; Female; Gonorrhea; Humans; Injections, Intramuscular; Treatment Outcome; Uterine Cervicitis

We evaluated the ability of the Etest (AB Biodisk, Solna, Sweden) method to accurately and reproducibly determine the antimicrobial susceptibility of Neisseria gonorrhoeae. One hundred gonococcal isolates were used to evaluate the diagnostic performance of the Etest compared with the reference agar dilution method for penicillin, tetracycline, ciprofloxacin, and ceftriaxone. Between 92 and 99% of Etest MIC results for all drugs were within +/- 1 log2 dilution of the reference MIC. According to recommended interpretive criteria, ceftriaxone, cefotaxime, and ciprofloxacin had 100% categorical agreement, while penicillin (86%) and tetracycline (85%) categorical agreement percentages were lower because of the large number of strains that were within 0.5 to 1 log2 dilution of the susceptible or resistant breakpoints. Reproducibility data also demonstrated that the Etest was precise (99.1%) when subjected to replicate testing. On the basis of these data, the Etest method provides an effective, simple alternative to the reference agar dilution method for the direct quantification of N. gonorrhoeae susceptibility.

Topics: Cefotaxime; Ceftriaxone; Ciprofloxacin; Drug Resistance, Microbial; Evaluation Studies as Topic; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Sensitivity and Specificity; Tetracycline

Topics: Cefotaxime; Ceftriaxone; Gonorrhea; Humans; Infant, Newborn; Injections, Intramuscular; Ophthalmia Neonatorum

Topics: Cefixime; Cefotaxime; Ceftriaxone; Gonorrhea; HIV Infections; Humans; Sexually Transmitted Diseases

Cefixime is a new third generation oral cephalosporin that exhibits excellent antibacterial activity against Neisseria gonorrhoeae, including beta-lactamase-positive strains. In an open uncontrolled clinical trial 14 male patients suffering from acute gonorrhea, aged 23 to 48 years, were treated with a single dose of 400 mg of cefixime. All 13 fully evaluable patients were clinically and bacteriologically cured. Side effects were not reported.

Topics: Acute Disease; Adult; Anti-Infective Agents; Cefixime; Cefotaxime; Drug Tolerance; Gonorrhea; Humans; Male; Middle Aged

Topics: Administration, Oral; Adolescent; Adult; Cefixime; Cefotaxime; Gonorrhea; Humans; Male; Neisseria gonorrhoeae

Seven patients (four men, three women) with gonococcal urethritis resistant to spectinomycin treatment were seen in May and June 1989 in the Department of Dermatology in Berlin (West), and strains of Neisseria gonorrhoeae (NG) resistant to spectinomycin were detected, cultured in vitro from these individuals. In five of the seven patients penicillin-resistant strains were found, including a penicillinase-producing strain in one case; the other two patients had penicillin-sensitive strains. In all cases the NG-populations detected were sensitive to cephalosporin and cipro(oxo)floxacin. In a 17-year-old young man with the PPNG strain severe gonococcal epididymitis developed after repeated infection that had been inadequately treated with spectinomycin. All seven patients mentioned sexual contact with individuals who lived in Southeast Asia or had their origins there; in at least four cases the contact persons came from Thailand. This is the first report on spectinomycin-resistant Neisseria gonorrhoeae infections (PPNG and non-PPNG) in the Federal Republic of Germany. The necessity for monitoring the results of penicillin and/or spectinomycin treatment of gonorrhoea are underlined for the dermatovenereologist, and some guidelines for therapy are given.

Topics: Adolescent; Adult; Cefotaxime; Ciprofloxacin; Epididymitis; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin Resistance; Spectinomycin; Urethritis

Two injections of klaforan, 1 g per injection, with a 12 hrs interval is an effective method for the therapy of male patients with fresh gonorrheal urethritis.

Topics: Adolescent; Adult; Cefotaxime; Drug Evaluation; Gonorrhea; Humans; Male; Urethritis

During recent decades there has been a controversial discussion if comparable plasma level profiles which are rather constant or those which show a high peak are more efficient for the cure of gonorrhoea. So far, investigations in this field were not based on the Grasso apparatus. Although the findings with cefotiam and ceftizoxime do not allow to formulate a general hypothesis without any restriction, it can be stated that on the basis of an identical area under the antibiotic level time curve, 'peak concentration' profiles are more favourable.

Topics: Anti-Bacterial Agents; Cefotaxime; Cefotiam; Ceftizoxime; Dose-Response Relationship, Drug; Gonorrhea; Humans

Cefotiam is clearly more active against Neisseria gonorrhoeae in vitro than penicillin. This applies especially to strains producing beta-lactamase but also to those which do not. No strain requires more than 0.25 micrograms/ml for inhibition. 1 g of cefotiam dissolved in 3 ml of 1% lidocaine solution cures 90.0% of patients suffering from uncomplicated genital gonorrhoea if injected once intramuscularly. Tolerance of this regimen is very good, no major side-effect being found.

Topics: Cefotaxime; Cefotiam; Female; Gonorrhea; Humans; Injections, Intramuscular; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae

Topics: Cefotaxime; Drug Therapy, Combination; Erythromycin; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillinase; Rifampin; Urethritis

Over 950 patients in the southeast region and south area of Los Angeles County were treated with cefotaxime and the effectiveness of its treatment is reported herein.

Topics: Cefotaxime; Female; Gonorrhea; Humans; Injections, Intramuscular; Male

Topics: Cefotaxime; Female; Gonorrhea; Humans; Male

To predict the clinical efficacy of a new antibiotic in uncomplicated gonorrhea, data pertinent to its pharmacokinetics in man are needed. Before starting clinical trials on cefotiam and cefmenoxime, 1 g of each antibiotic was administered intramuscularly as a single dose to 5 healthy volunteers. Both blood and skin blister fluid samples (obtained by suction and cantharides blistering) were repeatedly taken. Peak plasma levels amounted on average to 24.8 and 48.2 micrograms/ml, respectively. 6 h after dose still average plasma concentrations of 3.4 and 6.52 micrograms/ml were found. Suction blister fluid levels essentially paralleled plasma levels, whereas cantharides blister fluid levels increased and decreased more slowly than plasma levels. Cefotiam penetrated more readily into suction blister fluid than cefmenoxime as obtained from area ratios. Thus, the chosen dosage regimens considered apt for gonorrhea led to high initial as well as long-standing drug levels. And this does not only hold true for the plasma. Facing their good in vitro activity on Neisseria gonorrhoeae, cefotiam and cefmenoxime well deserve further studies in this field including clinical trials.

Topics: Adult; Blister; Cantharidin; Cefmenoxime; Cefotaxime; Cefotiam; Female; Gonorrhea; Humans; Injections, Intramuscular; Kinetics; Male; Suction

Ceftizoxime - a new beta-lactamase-resistant cephalosporin - was tested for its potential efficacy in the cure of uncomplicated gonorrhea. While more than a half of the 102 freshly isolated Neisseria gonorrhoeae strains examined was partially or totally resistant to penicillin (MIC greater than or equal to 0.06 microgram/ml), most of these strains proved highly susceptible to ceftizoxime (as well as cefotaxime). The MIC90% amounted to 0.004 micrograms/ml, while serum levels after the intramuscular application of as little as 0.5 g exceed 1 microgram/ml for more than 6 h. The clinical results were excellent. 105 male or female patients suffering from uncomplicated gonorrhea were treated with a single intramuscular application of 1 g of ceftizoxime. 61 of them reattended our clinic twice for follow-up. All of them were cured. Anaphylactic shock or rashes were not observed. Thus, we consider the intramuscular application of 1 g of ceftizoxime as a reliable and safe treatment for uncomplicated gonococcal urethritis and cervicitis.

Topics: Adolescent; Adult; Aged; Cefotaxime; Ceftizoxime; Drug Resistance, Microbial; Female; Gonorrhea; Humans; Injections, Intramuscular; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae

Of 118 patients infected with beta-lactamase producing Neisseria gonorrhoeae treated with cefotaxime 0.5 g, 95 returned for at least one assessment. There were no failures to eradicate genital or rectal infection, but three of four patients with pharyngeal infection failed to respond.

Topics: beta-Lactamases; Cefotaxime; Gonorrhea; Humans; Neisseria gonorrhoeae

Ceftriaxone was used in single intravenously dose of 1 g to treat 20 men with gonorrhoea caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) and non-PPNG. Of 14 patients followed up, 13 (92.9%) were cured. Cure rates for PPNG infections and non-PPNG infections were 100% and 90.9% respectively. No side effect was observed except 1 case of vomiting out of 20 cases. It is concluded that this drug is safe and effective in treating both PPNG and non-PPNG infections.

Topics: Adult; Cefotaxime; Ceftriaxone; Drug Evaluation; Drug Resistance, Microbial; Gonorrhea; Humans; Injections, Intravenous; Male; Neisseria gonorrhoeae; Urethritis

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.

Topics: Cefotaxime; Ceftizoxime; Drug Administration Schedule; Female; Gonorrhea; Humans; Male

Following a single intramuscular application of 1 g ceftizoxime, levels of the drug were determined in plasma as well as in suction blister fluid (SBF) and cantharides blister fluid (CBF). This regimen invariably led to both high and long-lasting plasma levels: 81 +/- 16 min post dose maximum plasma levels of 17.5 +/- 3.1 micrograms/ml were reached; 6 h post dose levels of 4.6 +/- 0.4 micrograms/ml were still found, i.e., 4375 and 1150 times, respectively, the MIC90% of Neisseria gonorrhoeae. The high plasma levels were parallelled by high concentrations in SBF, with peaks amounting to 8.4 +/- 1.0 micrograms/ml. Peak concentrations in CBF ranged from 8.1 to 15.7 micrograms/ml. Thus, the pharmacokinetic behavior of ceftizoxime given as a single intramuscular injection of 1 g explained the excellent clinical results of this regimen in uncomplicated gonorrhea.

Topics: Adult; Blister; Cantharidin; Cefotaxime; Ceftizoxime; Dose-Response Relationship, Drug; Female; Gonorrhea; Humans; Injections, Intramuscular; Male; Time Factors

One hundred and two patients with an uncomplicated infection due to penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) were treated with a single 1 g dose of cefotaxime. At follow-up within 15 days all genital and rectal infections were cured. Pharyngeal infections also seemed to respond to this treatment. A relatively high proportion (30.9%) of patients, however, developed post-gonococcal urethritis.

Topics: Adult; Cefotaxime; Drug Administration Schedule; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillinase; Urethritis

Topics: Adolescent; Adult; Cefotaxime; Female; Gonorrhea; Humans; Male; Middle Aged

Topics: Adult; beta-Lactamases; Cefotaxime; Cervix Uteri; Female; Gonorrhea; Humans; Infant, Newborn; Maternal-Fetal Exchange; Neisseria gonorrhoeae; Ophthalmia Neonatorum; Pregnancy; Pregnancy Complications, Infectious

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Escherichia coli Infections; Gonorrhea; Humans; Pseudomonas Infections

Topics: Adult; Cefotaxime; Gonorrhea; Humans; Male; Neisseria gonorrhoeae

Forty-one male patients with gonorrheal urethritis were treated with ceftizoxime (CZX) administered concomitantly probenecid at the urological ward of Tokyo Metropolitan Taito Hospital during the period from October, 1982 to February, 1983, and clinically evaluated. Eighty strains of Neisseria gonorrhoeae isolated from the clinical specimens of these patients were bacteriologically studied. Of the 80 strains, 12(15%) were PPNG strains and the other 68 strains were non-PPNG strains. MICs of PCG to the 12 PPNG strains were 3.13 - 25 micrograms/ml and to the 68 non-PPNG strains were 0.0122 - 3.13 micrograms/ml. While MICs of CZX to the PPNG strains were less than or equal to 0.003 - 0.024 micrograms/ml and to the non-PPNG strains were less than or equal to 0.003 - 0.05 micrograms/ml. Those patients with gonorrheal urethritis were given a single 0.5 g intramuscular dose of CZX and a single 1 g oral dose of probenecid. The following clinical findings were obtained: The clinical efficacy rate of 41 cases was 98%; excellent in 24, good in 16, poor in 1 case. All 3 patients with gonorrheal urethritis caused by PPNGs were cured with the treatment. No subjective side effects were found.

Topics: Adult; Cefotaxime; Ceftizoxime; Drug Evaluation; Drug Resistance, Microbial; Gonorrhea; Humans; Injections, Intramuscular; Male; Middle Aged; Neisseria gonorrhoeae; Urethritis

Topics: Adolescent; Adult; Cefotaxime; Gonorrhea; Humans; Male; Middle Aged; Neisseria gonorrhoeae; Penicillinase

Topics: Cefotaxime; Cephalosporins; Drug Resistance, Microbial; Gonorrhea; Humans; Neisseria gonorrhoeae; Spectinomycin

Thirty women with asymptomatic genital gonococcal contamination were cured with one single i.m. injection of 1 g cefotaxime. Seven hours after treatment, the antibiotic level in cervical fluid was found equivalent to the minimal bactericidal concentration for gonococcus strains. But cefotaxime does not appear useful in the prevention of meningococcal pharyngeal carriage.

Topics: Adult; Carrier State; Cefotaxime; Cephalosporins; Cervix Mucus; Female; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Saliva

Topics: Cefotaxime; Cephalosporins; Gonorrhea; Humans; Male; Urethritis

Topics: Cefotaxime; Cephalosporins; Drug Therapy, Combination; Gonorrhea; Humans; Male; Probenecid; Urethritis

Topics: Adolescent; Adult; Age Factors; Aged; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Male; Meningitis; Middle Aged; Respiratory Tract Infections; Sepsis; Sex Factors

Topics: Cefazolin; Cefotaxime; Cephalosporins; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae

HR 756, a new cephalosporin, was used in single intramuscular doses of 500 mg to treat 108 men and women with gonorrhoea caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) and non-PPNG. Of 102 patients followed up, 99 (97.05%) were cured. Cure rates for PPNG infections and non-PPNG infections were 98.18% and 95.74% respectively. Few adverse side effects were recorded but possible cross-sensitisation with penicillin was observed. Clinical and laboratory antibiotic susceptibility results correlated well. It is concluded that this drug is safe and effective in treating both PPNG and non-PPNG infectons.

Topics: Cefotaxime; Cephalosporins; Drug Tolerance; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillinase