Treatment of uncomplicated gonorrhea with rosoxacin

A VigiBase Descriptive Study of Fluoroquinolone-Associated Peripheral Nervous System Disorders

Background: Recent drug safety concerns described fluoroquinolone (FQ)-induced peripheral nervous system reactions. The objective of this study was to characterize such reports from VigiBase. Methods: The analysis included FQ-induced peripheral nervous system disorder adverse drug reaction (ADR) reports (up to July 2019). We looked into the disproportionality data in terms of proportional reporting ratio (PRR) and information component (IC) values, and descriptive analysis was performed for FQ-ADRs positive associations (ADRs, suspected FQs, potential risk factors, such as associated therapy and underlying disease). Results: Disproportionality analysis revealed 4374 reports (3531 serious) with peripheral nervous system ADRs associated with at least three FQs (neuropathy peripheral, 5492; neuralgia, 481; polyneuropathy, 220; sensory loss, 99; peripheral sensorimotor neuropathy, 39). Among these, both time-to-onset and duration of reaction were mostly between 1–7 days and ≥30 days. Most of the ADRs were not recovered/resolved at the time of reporting. Conclusion: The results augment the existing data on FQ safety concerns, specifically their potential effect on the nervous system.

Quinolone antimicrobial agents: adverse effects and bacterial resistance

Adverse effects, drug-drug interactions and bacterial resistance to the new quinolone antimicrobial agents are reviewed. Clinical adverse effects are reported to occur in 5-10% of patients, and include primarily gastrointestinal disturbances, central nervous system toxicity and rash. Laboratory abnormalities are reported to occur in 5-12% of patients, and include mild reversible elevations of transaminases. Quinolones are not recommended in persons whose bone growth is incomplete or in pregnant or nursing women because cartilage toxicity has been observed in juvenile beagles. Drug-drug interactions may occur between quinolones and theophylline, caffeine, and magnesium- or aluminium-containing compounds such as antacids and sucralfate. Bacterial resistance occurs by chromosomal mutations which alter the target enzyme DNA gyrase or decrease drug accumulation. Emergence of resistance during therapy is uncommon to date but can be problematic in infections with Pseudomonas aeruginosa. Staphylococcus aureus and other bacteria for which the therapeutic index may be low. In summary, quinolones thus far have been well tolerated, but more experience is needed to determine the exact nature and extent of adverse effects and emergence of bacterial resistance.

Fluoroquinolone antimicrobial agents

The fluoroquinolones, a new class of potent orally absorbed antimicrobial agents, are reviewed, considering structure, mechanisms of action and resistance, spectrum, variables affecting activity in vitro, pharmacokinetic properties, clinical efficacy, emergence of resistance, and tolerability. The primary bacterial target is the enzyme deoxyribonucleic acid gyrase. Bacterial resistance occurs by chromosomal mutations altering deoxyribonucleic acid gyrase and decreasing drug permeation. The drugs are bactericidal and potent in vitro against members of the family Enterobacteriaceae, Haemophilus spp., and Neisseria spp., have good activity against Pseudomonas aeruginosa and staphylococci, and (with several exceptions) are less potent against streptococci and have fair to poor activity against anaerobic species. Potency in vitro decreases in the presence of low pH, magnesium ions, or urine but is little affected by different media, increased inoculum, or serum. The effects of the drugs in combination with a beta-lactam or aminoglycoside are often additive, occasionally synergistic, and rarely antagonistic. The agents are orally absorbed, require at most twice-daily dosing, and achieve high concentrations in urine, feces, and kidney and good concentrations in lung, bone, prostate, and other tissues. The drugs are efficacious in treatment of a variety of bacterial infections, including uncomplicated and complicated urinary tract infections, bacterial gastroenteritis, and gonorrhea, and show promise for therapy of prostatitis, respiratory tract infections, osteomyelitis, and cutaneous infections, particularly when caused by aerobic gram-negative bacilli. Fluoroquinolones have also proved to be efficacious for prophylaxis against travelers' diarrhea and infection with gram-negative bacilli in neutropenic patients. The drugs are effective in eliminating carriage of Neisseria meningitidis. Patient tolerability appears acceptable, with gastrointestinal or central nervous system toxicities occurring most commonly, but only rarely necessitating discontinuance of therapy. In 17 of 18 prospective, randomized, double-blind comparisons with another agent or placebo, fluoroquinolones were tolerated as well as or better than the comparison regimen. Bacterial resistance has been uncommonly documented but occurs, most notably with P. aeruginosa and Staphylococcus aureus and occasionally other species for which the therapeutic ratio is less favorable. Fluoroquinolones offer an efficacious, well-tolerated, and cost-effective alternative to parenteral therapies of selected infections.

Adverse reactions in a dose-ranging study with a new long-acting fluoroquinolone, fleroxacin

New fluoroquinolones have generally been well tolerated. In a double-blind evaluation of oral fleroxacin, using 400, 600, or 800 mg once daily for 7 days in an ambulatory setting for treatment of uncomplicated genital infections, we encountered unexpectedly high rates of adverse reactions. The objective of this analysis was to determine whether any factors in addition to dose could be found to account for our observations. Adverse reactions developed in 66 (84%) of 79 individuals, and severe reactions arose in 38 (48%). Most frequent were central nervous system reactions (70%), with insomnia being especially frequent (49%); gastrointestinal reactions (39%) and photosensitivity reactions (10%) were also common. Development of any reaction (central nervous system reactions, insomnia, and severe intestinal reactions) was dose related. Development of photosensitivity reactions correlated with an outdoor occupation. No other factors, including usual daily caffeine use, correlated with the development of adverse reactions. In our study, fleroxacin taken as a single daily 600- or 800-mg dose was associated with an unacceptably high rate of adverse reactions. Other studies are required to determine whether this problem is unique to fleroxacin or will occur with higher doses of other fluoroquinolones possessing similar chemical modifications and/or good tissue penetration and very long half-lives.

Norfloxacin versus thiamphenicol for treatment of uncomplicated gonorrhea in Rwanda

In an open prospective study, single oral doses of norfloxacin (800 mg) and thiamphenicol (2.5 g) were used to treat, respectively, 122 and 46 consecutive patients with uncomplicated gonorrhea. Neisseria gonorrhoeae was eradicated from 119 (97.5%) patients treated with norfloxacin and from 35 (76.0%) patients treated with thiamphenicol. Norfloxacin treatment failure was not related to drug resistance or to insufficient absorption of the drug. Thiamphenicol failure correlated with low in vitro susceptibility of the infecting strain. In a single oral dose of 800 mg, norfloxacin appeared to be an excellent alternative treatment regimen for uncomplicated gonorrhea in an area with a high prevalence of penicillin-resistant gonococci.

Clinical evaluation of rosoxacin for the treatment of chancroid

One hundred seven men with Haemophilus ducreyi-positive chancroid were assigned to receive 300 mg of rosoxacin as a single dose or 150 mg twice daily for 3 days. Ulcers and buboes were followed clinically and bacteriologically for 1 month. Of 40 evaluable males on the 3-day regimen, 38 (95%) were cured, while only 14 of 23 (61%) males on the single-dose regimen were cured; this regimen was discontinued. There was one ulcer relapse at day 21 in both groups; the one relapse in the single-dose group had a persistent culture-positive bubo. Eight of nine (89%) buboes followed to the endpoint on the 3-day rosoxacin regimen were cured, versus three of six (50%) on the single-dose regimen. Adverse effects were mainly related to the central nervous system but were minor and did not require intervention. None of the treatment failures was due to organisms resistant to rosoxacin, and failure of the single-dose regimen presumably was related to duration of tissue levels rather than to drug resistance. Administration of 150 mg of rosoxacin twice daily for 3 days is an effective regimen for the therapy of chancroid and is a reasonable alternative to other short-course regimens.

Clinical experience with ofloxacin in sexually transmitted disease

Experience with ofloxacin in the United States in the treatment of sexually transmitted diseases is reviewed. In one study, a single oral dose of either 400 mg or 600 mg eradicated Neisseria gonorrhoeae in all 43 evaluable patients. In another multicenter study a seven-day course of ofloxacin 300 mg b.i.d. was as effective as a seven-day course of doxycycline 100 mg b.i.d. in eradicating N. gonorrhoeae, Chlamydia trachomatis and, in men, Ureaplasma urealyticum. Because of increasing problems with antimicrobial resistance, particularly among strains of N. gonorrhoeae, ofloxacin, with its unique mechanism of action, and its broad spectrum activity against pathogens, may prove useful in the treatment of sexually transmitted diseases.

Single dose ciprofloxacin for treating gonococcal infections in men

A single oral dose of ciprofloxacin 500 mg was used to treat five men with gonococcal urethritis and five men with gonococcal proctitis, and all were cured. In a subsequent study the dose of ciprofloxacin was reduced to 250 mg, and 54 men with 57 gonococcal infections (47 urethral, seven rectal, and three pharyngeal) were treated; of the isolates of Neisseria gonorrhoeae, four were penicillinase producing strains. All the patients were cured of gonococcal infection. Urethral specimens from nine of the men with gonococcal urethritis yielded Chlamydia trachomatis before treatment. These organisms were isolated again from all these patients seven days after treatment, and from a further seven men who had been chlamydia negative before treatment. It is concluded that a single oral dose of ciprofloxacin is an effective treatment for uncomplicated gonorrhoea, but is ineffective against C trachomatis. Of the 54 men given 250 mg ciprofloxacin, six (11%) showed minor abnormalities of liver function tests after treatment.

Unsuccessful treatment of non-gonococcal urethritis with rosoxacin provides information on the aetiology of the disease

In a controlled trial of rosoxacin in patients with non-gonococcal urethritis (NGU), 150 mg of the antibiotic given twice daily for 10 days was compared with 300 mg triple tetracycline (Deteclo) given twice daily for the same period. Only six (19%) of 31 patients treated with rosoxacin were free of urethritis after 10 days; Chlamydia trachomatis was reisolated from 12 (92%) of 13 patients who were chlamydia positive originally, and Ureaplasma urealyticum was reisolated from 12 (80%) of 15 patients who were ureaplasma positive originally. In contrast, 18 (58%) of 31 patients treated with triple tetracycline were cured clinically after 10 days; C trachomatis was not reisolated from any of 10 patients who were chlamydia positive originally, and U urealyticum was reisolated from only three (17%) of 18 patients who were ureaplasma positive originally. These results were consistent with the antimicrobial inactivity of rosoxacin in vitro and they cannot be reconciled with previous reports of successful use of this antibiotic in NGU. Ureaplasmas were isolated more frequently and in larger numbers from chlamydia negative than from chlamydia positive patients, but it is probable that ureaplasmas resistant to tetracycline were not responsible for persistent urethritis.

In vitro activities of the spectinomycin analog U-63366 and four quinolone derivatives against Neisseria gonorrhoeae

The in vitro activities of the new spectinomycin analog U-63366 and four new quinolone derivatives, rosoxacin, norfloxacin, ofloxacin, and ciprofloxacin, were compared with those of penicillin, tetracycline, thiamphenicol, cefotaxime, ceftriaxone, and spectinomycin against 222 beta-lactamase-negative and 25 beta-lactamase-positive Neisseria gonorrhoeae strains. U-63366 was more active than spectinomycin, inhibiting 90% of the strains at a concentration of 2 mg/liter. Among the quinolone derivatives, ciprofloxacin was the most active compound in vitro (90% MIC, 0.002 mg/liter), followed by ofloxacin (90% MIC, 0.008 mg/liter), norfloxacin (90% MIC, 0.015 mg/liter), and rosoxacin (90% MIC, 0.03 mg/liter).

Treatment of uncomplicated gonorrhoea with rosoxacin (acrosoxacin)

An open study was designed primarily to evaluate the efficacy of rosoxacin in the treatment of gonorrhoea caused by penicillinase producing Neisseria gonorrhoeae (PPNG) and non-PPNG strains. A total of 199 patients (99 men and 100 women) satisfactorily completed follow up examinations, 50 men and 50 women having received rosoxacin 300 mg orally and the remainder having received kanamycin 2 g intramuscularly. Rosoxacin achieved an overall cure rate of 94% (96.7% for PPNG and 90% for non-PPNG strains). In patients treated with kanamycin the overall cure rate was 89.9% (92.7% for PPNG and 83.3% for non-PPNG strains). A correlation between treatment failures and minimum inhibitory concentrations (MICs) of rosoxacin was noted in non-PPNG strains but not in PPNG strains. Side effects which were mild and self limiting were noted in 15 of 100 patients treated with rosoxacin. The high failure rates associated with non-PPNG strains requiring MICs of 0.125 mg/l and the observation of a substantial rise in the MICs for isolates after treatment is of concern. Otherwise, rosoxacin in a single dose of 300 mg appears to be safe and effective for the treatment of uncomplicated gonorrhoea.

Rosoxacin in the therapy of uncomplicated gonorrhea

In this randomized, multicentered study, 157 males and 130 females with laboratory-confirmed, uncomplicated anogenital Neisseria gonorrhoeae infections were evaluated to determine the efficacy and safety of a single 300-mg oral dose of rosoxacin versus 3.5 g of ampicillin plus 1 g of probenecid. A total of 130 males and 101 females were evaluated. Rosoxacin cured 90.3% (P = 0.053) and 94.1% (P = 0.62), respectively, whereas ampicillin was effective in 98.5 and 98% of males and females, respectively. All 39 patients with anorectal infections were cured. One penicillinase-producing N. gonorrhoeae strain was isolated and was eradicated with rosoxacin. Of 212 pretreatment isolates tested, 201 were inhibited by 0.06 micrograms or less of rosoxacin per ml. The MICs of rosoxacin for the remaining 11 isolates ranged up to 0.5 micrograms/ml. The incidence of adverse effects was relatively high (29% for the rosoxacin group versus 18% for the ampicillin group), but none of the reactions required medical intervention nor did they result in serious sequelae.

Comparative in vitro activity of Sch 29,482, a new oral penem, against Neisseria gonorrhoeae

The in vitro activity of Sch 29,482, a new oral beta-lactam antimicrobial agent, was compared with those of norfloxacin, rosoxacin, ampicillin, erythromycin, and tetracycline against 142 Neisseria gonorrhoeae strains. Sch 29,482 was as active as norfloxacin and rosoxacin. Its activity was greater than the other three antimicrobial agents. It inhibited 90% of the isolates, regardless of beta-lactamase activity, at a concentration of less than or equal to 0.06 micrograms/ml.