cefoxitin and Gonorrhea

The first two known cases of Neisseria gonorrhoeae infection of a penile implant are reported. The literature regarding periprosthetic infections is reviewed, and the mode of transmission of the gonococcal organism to the corpora is discussed.

Topics: Adult; Cefoxitin; Erectile Dysfunction; Gonorrhea; Humans; Male; Middle Aged; Postoperative Complications; Prostheses and Implants; Prosthesis Failure; Tetracycline

Topics: Bacterial Infections; Bacteroides Infections; Cefamandole; Cefazolin; Cefonicid; Cefoxitin; Cefuroxime; Cephalosporins; Gonorrhea; Haemophilus Infections; Humans; Respiratory Tract Infections; Structure-Activity Relationship

We investigated the association between endometritis and reproductive morbidity.. Participants were 614 women in the PID Evaluation and Clinical Health (PEACH) Study with pelvic pain, pelvic organ tenderness, and leukorrhea, mucopurulent cervicitis, or untreated cervicitis. We compared women with endometritis (>or=5 neutrophils or >or=2 plasma cells), Neisseria gonorrhoeae or Chlamydia trachomatis upper genital tract infection (UGTI) or both to women without endometritis/UGTI for outcomes of pregnancy, infertility, recurrent pelvic inflammatory disease (PID), and chronic pelvic pain (CPP), adjusting for age, race, education, PID history, and baseline infertility.. Endometritis/UGTI was not associated with reduced pregnancy (odds ratio [OR] 0.8, 95% CI 0.6-1.2) or elevated infertility (OR 1.0, 95% CI 0.6-1.6), recurrent PID (OR 0.6, 95% CI 0.4-0.9), or CPP (OR 0.6, 95% CI 0.4-0.9). PEACH participants with and without endometritis/UGTI had higher age- and race-specific pregnancy rates than 1997 national rates.. Among women with clinically suspected mild-to-moderate PID treated with standard antibiotics, endometritis/UGTI was not associated with reproductive morbidity.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacteria, Anaerobic; Bacterial Infections; Cefoxitin; Chlamydia Infections; Doxycycline; Endometritis; Endometrium; Female; Gonorrhea; Humans; Infertility, Female; Odds Ratio; Pelvic Inflammatory Disease; Pregnancy; Probenecid; Time Factors

A multicenter randomized comparative trial was done to assess the safety and efficacy of oral ofloxacin (400 mg twice daily for 10 days) versus cefoxitin (2 g intramuscularly) followed by doxycycline (100 mg twice daily orally for 10 days) for the outpatient treatment of uncomplicated pelvic inflammatory disease (PID). Neisseria gonorrhoeae (GC) grew on pretreatment endocervical cultures from 43 of 268 women (16%), and in 30 of 247 women (12%) cultures were positive for Chlamydia trachomatis (Ct). Ninety-five percent (122/128) of the women treated with the ofloxacin regimen and 93% (112/121) of those treated with the cefoxitin/doxycycline regimen had cure or improvement on examination at a minimum of one follow-up visit. All GC species were eradicated by both ofloxacin and cefoxitin. Among women who returned for follow-up, the eradication of C trachomatis was 88% (15/17) for the cefoxitin/doxycycline group and 100% (18/18) for ofloxacin. Side effects were more prevalent in the cefoxitin/doxycycline group (15%) than in the ofloxacin group (7%), nausea/vomiting being the most frequent adverse effect. In this study, it appears that ofloxacin and cefoxitin/doxycycline have similar clinical effectiveness for the outpatient treatment of uncomplicated pelvic inflammatory disease.

Topics: Adolescent; Adult; Ambulatory Care; Cefoxitin; Chlamydia Infections; Chlamydia trachomatis; Doxycycline; Drug Therapy, Combination; Female; Gonorrhea; Humans; Middle Aged; Ofloxacin; Pelvic Inflammatory Disease; Probenecid; Treatment Outcome

The object of this randomized study was to compare the safety and efficacy of oral ofloxacin, 400 mg twice daily for 10 days, versus intramuscular cefoxitin, 2 gm, plus oral probenecid, 1 gm, followed by oral doxycycline, 100 mg twice daily for 10 days, in the outpatient treatment of uncomplicated acute salpingitis. Thirty-eight women (53%) had Neisseria gonorrhoeae from their pretreatment endocervical or endometrial cultures, and 18 had Chlamydia trachomatis (25%). Thirty-five of 37 women (95%) treated with the ofloxacin regimen were clinically cured, and 34 of 35 (97%) were cured with the cefoxitin-doxycycline regimen (p = 0.52). One clinical failure occurred in each group with N. gonorrhoeae infection, and one failure occurred in the ofloxacin group because of side effects. The bacteriologic response for N. gonorrhoeae in both groups was 100%. The eradication of C. trachomatis was 100% (10/10) for the cefoxitin/doxycycline group and 86% (6/7) for ofloxacin. The side effects were similar in both groups of subjects. In this study both regimens were effective for the outpatient treatment of uncomplicated acute salpingitis.

Topics: Acute Disease; Adult; Ambulatory Care; Cefoxitin; Chi-Square Distribution; Chlamydia Infections; Chlamydia trachomatis; Doxycycline; Drug Therapy, Combination; Female; Gonorrhea; Humans; Ofloxacin; Probenecid; Salpingitis

Acute pelvic inflammatory disease remains the major medical and economic consequence of sexually transmitted diseases among young women. The polymicrobial origins of pelvic inflammatory disease have been well documented and the major organisms recovered from the upper genital tract in patients with pelvic inflammatory disease include Chlamydia trachomatis, Neisseria gonorrhoeae, and mixed anaerobic and aerobic bacteria. This study was undertaken to compare the efficacy and safety of cefotetan plus doxycycline with that of cefoxitin plus doxycycline in the treatment of hospitalized patients with acute pelvic inflammatory disease. A total of 68 hospitalized patients with acute pelvic inflammatory disease were entered and randomized into two treatment groups: cefotetan (n = 32) and cefoxitin (n = 36). There were six tuboovarian abscesses in each group. C. trachomatis was recovered from 7 (10%) and N. gonorrhoeae from 48 (71%) of the patients. Anaerobic and aerobic bacteria were recovered from the upper genital tract in 53 (78%) of the patients. Cefotetan plus doxycycline and cefoxitin plus doxycycline demonstrated high rates of initial clinical response in the treatment of acute pelvic inflammatory disease. Clinical cure was noted in 30 (94%) of the cefotetan plus doxycycline group and 33 (92%) of the cefoxitin plus doxycycline group. Four failures were sonographically diagnosed tuboovarian abscesses that responded to clindamycin plus gentamicin therapy. The fifth failure was an uncomplicated case that did not respond to cefoxitin and doxycycline and required additional therapy. At 1 week and 3 weeks, respectively, the posttreatment cultures demonstrated eradication, in all instances, of N. gonorrhoeae and C. trachomatis. These regimens also were very effective in eradicating anaerobic and aerobic pathogens from the endometrial cavity. Both regimens were well tolerated by the patients, and few adverse drug affects were noted.

Topics: Acute Disease; Adolescent; Adult; Cefotetan; Cefoxitin; Cephamycins; Chlamydia Infections; Doxycycline; Drug Therapy, Combination; Female; Gonorrhea; Hospitalization; Humans; Pelvic Inflammatory Disease

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

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

Gonococci that resist standard penicillin regimens by production of a penicillinase are now well established in certain areas of the world. Because cefoxitin, a semisynthetic cephamycin, resists gonococcal penicillinase in vitro, we compared procaine penicillin G and cefoxitin in treatment of gonorrhea in an area where 40 per cent of isolates produce penicillinase. One hundred and seven men with culture-proved gonococcal urethritis were given a single dose of either procaine penicillin G, 4.8 million U, or cefoxitin, 2 g, intramuscularly. Both groups took 1 g of probenecid orally; cefoxitin was given with lidocaine to reduce pain at the injection site. In men infected with penicillinase-negative gonococci, both cefoxitin and penicillin were highly effective. Penicillin failed in 77 per cent of men with penicillinase-positive strains, whereas cefoxitin was completely successful. Cefoxitin is an effective alternative to spectinomycin for single-session therapy of urethritis caused by penicillinase-producing Neisseria gonorrhoeae.

Topics: beta-Lactamases; Cefoxitin; Cephalosporins; Follow-Up Studies; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G Procaine; Penicillin Resistance; Penicillinase; Probenecid; Urethritis

The Gonococcal Isolate Surveillance Project is a national sentinel surveillance system to estimate levels and monitor trends of antimicrobial resistance in prospectively collected isolates of Neisseria gonorrhoeae. Of 6204 isolates evaluated from 21 clinic sites between September 1987 and December 1988, 21% met at least one of the surveillance criteria for resistance to penicillin, tetracycline, cefoxitin, or spectinomycin; 2.2% were penicillinase-producing N gonorrhoeae; 1.0% had high-level plasmid-mediated tetracycline resistance; and 16.8% of the isolates without plasmid-mediated resistance had chromosomally mediated resistance (defined as a minimum inhibitory concentration greater than or equal to 2 micrograms/mL) to penicillin, tetracycline, or cefoxitin. Three isolates were resistant to spectinomycin. All isolates were susceptible to ceftriaxone. Resistant isolates were identified from all participating centers. Patient demographic and behavioral characteristics were not predictive of infections caused by resistant organisms. These results demonstrate the wide distribution of antimicrobial-resistant N gonorrhoeae and support recent changes in Centers for Disease Control therapy recommendations for gonococcal infections that no longer recommend tetracycline and penicillin as first-line therapies.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cefoxitin; Child; Drug Resistance, Microbial; Gonorrhea; Humans; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Penicillin Resistance; Population Surveillance; Spectinomycin; Tetracycline Resistance; United States

Sixty-three women with abdominal pain and adnexal tenderness were enrolled in a study of ambulatory treatment of acute pelvic inflammatory disease. Treatment consisted of 2 g of cefoxitin intramuscularly and 1 g of probenecid orally, followed by doxycycline, 100 mg by mouth twice daily for 14 days. Patients were stratified into groups indicating whether pelvic inflammatory disease was probable, possible, or unlikely, based upon endometrial biopsy and clinical criteria. Among 52 women who were evaluated, Chlamydia trachomatis and/or Neisseria gonorrhoeae were initially recovered from 16 (67%) of 24 with probable pelvic inflammatory disease, three (33%) of 11 with possible pelvic inflammatory disease, and three (18%) of 17 in whom pelvic inflammatory disease was considered unlikely. Of the 24 patients with probable pelvic inflammatory disease, 22 (92%) were clinically cured or improved. Of 22 patients initially infected with C trachomatis and/or N gonorrhoeae, 20 were culture-negative for both organisms after therapy. Both microbiologic failures had been reexposed. This study suggests that the combination of cefoxitin and doxycycline is effective for ambulatory treatment of pelvic inflammatory disease.

Topics: Adult; Ambulatory Care; Biopsy; Cefoxitin; Chlamydia Infections; Doxycycline; Endometritis; Female; Follow-Up Studies; Gastrointestinal Diseases; Gonorrhea; Humans; Pelvic Inflammatory Disease; Salpingitis

The official records of uncomplicated gonorrhoea for Córdoba state show that between 1975 and 1985, about one in 1000 sexually active people acquired gonorrhoea each year. A study was therefore undertaken to obtain information about treatment of uncomplicated gonorrhoea, as well as the nutritional requirements, plasmid analyses, and susceptibility profiles of gonococci in this geographical area. From August 1983 to April 1984, 219 men with uncomplicated gonorrhoea were treated with one of four antibiotic schedules, all of which were over 95% efficient. All 98 strains isolated and purified were non-penicillinase-producing Neisseria gonorrhoeae (non-PPNG). The minimum inhibitory concentrations (MICs) of benzylpenicillin, tetracycline, thiamphenicol, spectinomycin, kanamycin, and cefoxitin were assessed. The MIC of benzylpenicillin showed that 88% (86) of the strains were inhibited by 0.5 mg/l of the drug, and also showed a bimodal sensitivity pattern to that antibiotic. The nutritional requirements of the 62 strains tested showed that 53% (33) were of the non-requiring (wild type) auxotype, 42% (26) required proline (pro-) and 5% (3) required proline and arginine (pro- arg-). Resistance to antibiotics was more notable in the pro- than in the wild type strains.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Argentina; Cefoxitin; Drug Resistance, Microbial; Gonorrhea; Humans; Kanamycin; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Penicillin G; Plasmids; Spectinomycin; Tetracycline; Thiamphenicol; Urethra

Between April 1983 and December 1985, 576 strains of Neisseria gonorrhoeae were isolated in our laboratory from patients attending Sexually Transmitted Diseases (STD) clinics. Of these, 61 (10.6%) were penicillinase-producing. Studies on these strains by plasmid analysis, auxotyping and serogrouping showed that the predominant type strains harboured the Asian resistance plasmid, were prototrophic, and were of serogroup W II/W III. About half of the strains, both of the African and Asian type, harboured the transfer plasmid. Strains of serogroup W II/W III were less sensitive to tetracycline and cefoxitin than serogroup W I strains.

Topics: Cefoxitin; Ceftazidime; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G; Penicillinase; Plasmids; Serotyping; Spain; Spectinomycin; Tetracycline

Topics: Adult; Arthritis, Infectious; Cefoxitin; Ceftriaxone; Drug Resistance, Microbial; Female; Gonorrhea; Humans; Middle Aged; Penicillin Resistance; Tetracycline Resistance

A total of 136 patients with uncomplicated gonorrhoea were treated with intramuscular cefoxitin 2 g (25 patients) or 1 g (111 patients) and oral probenecid 1 g. Cefoxitin 1 g cured 95% (42 out of 45 men and all of 14 women) with infections caused by penicillinase producing Neisseria gonorrhoeae (PPNG) strains and 98% (all of 38 men and 13 out of 14 women) with non-PPNG infections, giving an overall cure rate of 96%. The rate of postgonococcal urethritis (PGU) in men treated with 1 g cefoxitin was 28%. No serious side effects of treatment were observed in patients treated with either dose. The failure rate of 7% in men infected with PPNG strains who were treated with the 1 g dose is, however, disturbing. We therefore recommend that intramuscular cefoxitin 2 g and oral probenecid 1 g may be used to treat uncomplicated gonorrhoea, especially in areas where PPNG strains are common.

Topics: Cefoxitin; Drug Therapy, Combination; Female; Gonorrhea; Humans; Injections, Intramuscular; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillinase; Probenecid

Topics: Anti-Bacterial Agents; Cefoxitin; Cefuroxime; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin Resistance; Penicillinase; Penicillins

This article reviews the rationale for the therapy of acute salpingitis and the conceptual basis for the length of therapy. The key to therapy of acute salpingitis is the need to accommodate polymicrobial etiology, polymicrobial bacterial superinfection, and the potential presence of penicillinase-producing strains of Neisseria gonorrhoeae into a therapeutic equation that has been determined by the appropriate staging of disease. The anticipated therapeutic response identified for monomicrobial disease due to Neisseria gonorrhoeae constitutes the end titration point for drug administration. Duration of continued therapy beyond this point is governed by the need to complete therapy for Chlamydia trachomatis or to assure resolution of advanced disease.

Topics: Acute Disease; Anti-Bacterial Agents; Cefoxitin; Chlamydia Infections; Chlamydia trachomatis; Doxycycline; Drug Therapy, Combination; Female; Gonorrhea; Humans; Metronidazole; Neisseria gonorrhoeae; Penicillinase; Salpingitis; Time Factors

The treatment regimen for penicillin sensitive gonococcal conjunctivitis in an adult normally includes parenteral penicillin, frequent ocular irrigation, and topical ophthalmic gentamicin or tetracycline ointment. However, if a conjunctivitis is caused by a beta-lactamase producing microbe such as PPNG, then different antibiotics are required: e.g., spectinomycin or cefoxitin parenterally and topical chloramphenicol. Also, whereas urethritis is frequently treated with singular injections of penicillin or spectinomycin HCI (Trobicin), cases of PPNG ocular infections require a much longer course of treatment often involving seven days of intramuscular or intravenous antibiotics.

Topics: Adult; Cefoxitin; Chloramphenicol; Conjunctivitis; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin Resistance; Spectinomycin

Topics: Anti-Bacterial Agents; Cefoxitin; Drug Resistance, Microbial; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin Resistance; Tetracycline

Topics: Cefoxitin; Female; Gonorrhea; Humans; Male; Penicillin G Procaine

Topics: Adolescent; Adult; Cefoxitin; Drug Evaluation; Gonorrhea; Humans; Male; Penicillin G Procaine; Spectinomycin

Topics: Anti-Bacterial Agents; Cefoxitin; Gonorrhea; Humans; Kanamycin; Male; Neisseria gonorrhoeae; Penicillin G Procaine; Penicillin Resistance; Penicillinase; Spectinomycin; Thailand; Thiamphenicol

Complicated infections caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) are uncommon. Of two patients with prostatitis due to PPNG, one was cured by cefoxitin followed by co-trimoxazole, the other by co-trimoxazole alone. The potential of co-trimoxazole in the treatment of PPNG-prostatitis looks promising.

Topics: Adult; Cefoxitin; Drug Combinations; Epididymitis; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Orchitis; Penicillinase; Prostatitis; Sulfadiazine; Trimethoprim

Topics: Cefoxitin; Drug Resistance, Microbial; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Spectinomycin; Tetracyclines; United Kingdom

Cefoxitin (mefoxin), a new semisynthetic cephamycin antibiotic, resistant to degradation by beta-lactamase enzymes produced by bacteria. In vitro, cefoxitin is active against virtually all clinically important gram-negative facultative bacteria other than Pseudomonas and Enterobacter spp., gram-positive aerobic bacteria other than the enterococcus, and clinically important anaerobic organisms, including Bacteroides fragilis. This broad antibacterial spectrum suggested that cefoxitin might be an effective single antibiotic agent for the treatment of mixed aerobic-anaerobic infections in obstetric and gynecologic patients. In this investigation, the efficacy and safety of cefoxitin was evaluated in 109 patients--68 with salpingitis, 25 with endomyometritis, 9 with pelvic cellulitis, and 7 with pelvic abscesses. An average of 2.5 bacteria were isolated from each patient. Aerobic bacteria alone was isolated in 38% of patients, anaerobic bacteria alone in 25%, and a combination of aerobic and anaerobic bacteria was isolated in 37% of patients. Overall, 100 of 109 (92%) infections responded to treatment with cefoxitin alone. The major cause of treatment failure was the presence of abscesses requiring surgical drainage. In addition to being an effective single agent for the management of pelvic infections, cefoxitin proved to be safe and well tolerated by patients.

Topics: Abscess; Acute Disease; Adolescent; Adult; Aerobiosis; Anaerobiosis; Bacterial Infections; Bacteroides Infections; Cefoxitin; Cellulitis; Cephalosporins; Female; Gonorrhea; Humans; Middle Aged; Pelvis; Salpingitis