cefotaxime and Syphilis

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

A procedure dating back to the early penicillin era is adapted in order to determine the activity of the new cephalosporins ceftizoxime and ceftriaxone against Treponema pallidum in vitro. While the well-known activity of penicillin G is confirmed for the virulent Nichols strain (0.002 micrograms/ml lead to 50% immobilisation) the new cephalosporins turn out to be almost as efficacious. The concentration of ceftizoxime leading to 50% inhibition amounts to 0.004 micrograms/ml. The corresponding figure for ceftriaxone is 0.01 micrograms/ml. The potential importance of these findings for the treatment of syphilis in man are discussed.

Topics: Animals; Cefotaxime; Ceftizoxime; Ceftriaxone; Male; Microbial Sensitivity Tests; Penicillin G; Rabbits; Syphilis; Treponema pallidum

The activity of ceftriaxone, a newly developed cephalosporin, against early cutaneous infections with Treponema pallidum in rabbits was compared with that of equimolar doses of penicillin G. Activity was related to the time required for cutaneous lesions to become dark-field negative, serological response, and the disappearance of T. pallidum from the popliteal lymph nodes. Both antibiotics were very effective in the treatment of syphilis in this animal model. The 50% curative dose for penicillin G was 0.8 mumol/kg (0.29 mg or 480 U/kg) and for ceftriaxone, it was 1.45 mumol/kg (0.96 mg/kg). Overall, ceftriaxone was slightly less effective than penicillin G was. Transmission and scanning electron microscopy studies of testicular aspirates obtained from rabbits treated with ceftriaxone revealed alterations in the treponeme surface which apparently resulted in changes in cell permeability and morphology.

Topics: Animals; Antibody Formation; Cefotaxime; Ceftriaxone; Lymph Nodes; Male; Penicillin G; Rabbits; Syphilis; Treponema pallidum