cefotaxime and Urethritis

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

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

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

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

In a randomized comparative study, 83 male patients suffering from acute uncomplicated gonococcal urethritis were treated with a single dose of either 0.8 g pefloxacin, given orally, or 1.0 g cefotaxime, given intramuscularly. The cure rates were 100% in both treatment groups four to seven days and 21 to 31 days, respectively, after therapy. The MICs of the isolated Neisseria gonorrhoeae ranged from 0.008 to 0.06 mg/l for pefloxacin and from 0.0005 to 0.03 mg/l for cefotaxime. Postgonococcal urethritis was found in 9% of the patients treated with pefloxacin and in 20% of the patients treated with cefotaxime. Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum were isolated from 15%, 7% and 22% of the patients, respectively, before therapy and from 22%, 11% and 20% of the patients, respectively, 21 to 31 days after therapy. Both antibiotics had no effect on the presence of these microorganisms. No side effects were recorded in either groups of patients except that 46% of the patients treated with cefotaxime reported mild pain at the injection site. In conclusion, pefloxacin and cefotaxime are safe and effective agents in the treatment of uncomplicated gonococcal urethritis in men.

Topics: Administration, Oral; Adult; Cefotaxime; Humans; Injections, Intramuscular; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Pefloxacin; Remission Induction; Urethritis

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

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

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

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

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

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

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

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

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

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