PROBENECID AS AN ADJUVANT IN THE TREATMENT OF GONORRHOEA WITH PENICILLIN

Intravenous (IV) cefazolin with oral probenecid: A novel daily regimen for the management of Methicillin Sensitive Staphylococcus aureus (MSSA) bacteremia in a patient with renal dysfunction

A 78 year old man developed a methicillin sensitive Staphylococcus aureus (MSSA) post-operative wound infection following an elective L2-L4 laminectomy. He was treated with surgical debridement which was to be followed by a planned 6 weeks course of cefazolin. However, two weeks post debridement, a follow-up MRI revealed an L3-L5 epidural abscess, septic arthritis and vertebral osteomyelitis prompting repeat surgical debridement. No purulence was noted, and operative cultures were negative for growth. His hospital course was complicated by acute kidney injury and a renal biopsy reveled crescentic glomerulonephritis consistent with post infectious glomerulonephritis. He was treated with daptomycin, followed by oral linezolid. Five months after his original laminectomy, he developed purulent drainage from his back wound. Blood cultures grew MSSA and a repeat aspirate done by interventional radiology also grew MSSA. He improved with nafcillin and was transitioned to telavancin on discharge to facilitate once daily treatment. While on telavancin he developed increasing back pain and fever. Therefore, the regimen was changed to IV cefazolin and oral probenecid for five weeks followed by oral cephalexin to complete a total of 12 weeks of therapy. There is no evidence of disease recurrence one year after completion of therapy. IV cefazolin with oral probenecid may represent a once daily IV treatment option for patients with MSSA bacteremia and kidney disease.

One-session treatment of gonorrhoea in males with procaine penicillin plus probenecid

Six hundred and thirteen male patients with acute uncomplicated gonorrhoea have been treated alternately with single injections of 1·2 mega-units of aqueous procaine penicillin alone or with the same dose and preparation of penicillin with an additional 1·0 g of probenecid given orally immediately prior to injection.

Whether the failure rates were assessed on the basis of an absence of further sexual exposure or by classifying all recurrences within 1 or 2 weeks regardless of history as treatment failures the results were significantly better when probenecid was also given.

The use of a single dose of probenecid is thus capable of maintaining the success of single injection procedures for the treatment of gonorrhoea based on procaine penicillin and thus represents a bulwark for the future should the powers of penicillin against the gonococcus in London deteriorate further.