HR 756--a new cephalosporin in the treatment of gonorrhoea caused by ordinary and penicillinase-producing strains of Neisseria gonorrhoeae

In vitro activity of Ro 15-8074, a new oral cephalosporin, against Neisseria gonorrhoeae

Ro 15-8074, a new cephalosporin the pivaloyloxymethylester of which (Ro 15-8075) is orally absorbable, showed greater in vitro activity than cefaclor against 48 Neisseria gonorrhoeae strains, including 25 penicillinase-producing strains. Unlike cefaclor, Ro 15-8074 was unaffected by increase in inoculum size, and it exhibited a remarkable stability against gonococcal beta-lactamase hydrolysis.

Randomised comparative study of ceftriaxone and spectinomycin in gonorrhoea

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.

Rosoxacin in the treatment of uncomplicated gonorrhoea in men

Between 3 January and 4 March 1983 we treated 200 male patients diagnosed as having uncomplicated gonococcal urethritis with one of two regimens. They were divided into two groups and randomly assigned to treatment with either 2 g spectinomycin administered intramuscularly (group A) or 300 mg rosoxacin by mouth (group B). Of 187 isolates tested for the production of beta-lactamase, 101 (54%) were penicillinase producing Neisseria gonorrhoeae (PPNG) strains. All 81 cases followed in group A (spectinomycin) were cured, compared with 88.5% (77 out of 87) of the patients followed in group B (rosoxacin). We concluded that rosoxacin at a dosage of 300 mg administered orally was fairly effective in the treatment of gonococcal urethritis in men caused by both PPNG and non-PPNG strains.

Two dose Augmentin treatment of acute gonorrhoea in men

We studied 192 men with acute gonococcal urethritis, 97 of whom received two oral doses of Augmentin (amoxycillin 3 g and clavulanic acid 250 mg) separated by a four hour interval; the remaining 95 received 2 g kanamycin in a single intramuscular injection. Of the patients treated with Augmentin, 93 (95.9%) were cured, which was significantly more than the 83 (87.4%) patients treated with kanamycin. Augmentin was equally effective in the treatment of penicillinase producing Neisseria gonorrhoeae (PPNG) and non-PPNG infections, the cure rates for which were 96.6% and 95.6% respectively.

Cefaclor and cefamandole as alternatives to spectinomycin in the treatment of men with uncomplicated gonorrhoea

Between 25 December 1981 and 11 March 1982, 400 men with uncomplicated gonococcal urethritis were randomly assigned to one of four treatment regimens: spectinomycin 2 g intramuscularly (group A); cefamandole 1 g intramuscularly after probenecid 1 g orally (group B); cefaclor 3 g orally with probenecid 1 g orally (group C); and cefaclor 3 g orally (group D). The cure rates were 91 of 92 (98.9%) in group A, 68 of 96 (70.8%) in group B, 88 of 92 (95.8%) in group C, and 86 of 96 (89.6%) in group D. Cefaclor at a dose of 3 g given orally with 1 g probenecid appears to be an effective alternative to spectinomycin 2 g in the treatment of gonorrhoea in areas where strains of penicillinase producing Neisseria gonorrhoeae (PPNG) are prevalent.

Cefotaxime. A review of its antibacterial activity, pharmacological properties and therapeutic use

SYNOPSIS

Cefotaxime is a new 'third generation' semisynthetic cephalosporin administered intravenously or intramuscularly. It has a broad spectrum of activity against Gram-positive and Gram-negative aerobic and anaerobic bacteria, and is generally more active against Gram-negative bacteria than the 'first' and 'second generation' cephalosporins. Although cefotaxime has some activity against Pseudomonas aeruginosa, on the basis of present evidence it cannot be recommended as sole antibiotic therapy for pseudomonal infections. However, cefotaxime has been effective in treating infections due to other 'difficult' organisms, such as multidrug-resistant Enterobacteriaceae. Like other cephalosporins, cefotaxime is effective in treating patients with complicated urinary tract and lower respiratory tract infections, particularly pneumonia caused by Gram-negative bacilli. High response rates have also been achieved in patients with Gram-negative bacteraemia. Although favourable clinical results have been obtained in patients with infections caused by mixed aerobic/anaerobic organisms (such as peritonitis or soft tissue infections), the relatively low in vitro activity of cefotaxime against Bacteroides fragilis may restrict its usage in situations where this organism is the suspected or proven pathogen. In preliminary studies, males and females treated with a single intramuscular dose of cefotaxime for uncomplicated gonorrhoea caused by penicillinase-producing strains of Neisseria gonorrhoeae responded very favourably. Encouraging results have also been reported in open studies in children including neonates, treated with cefotaxime for meningitis and various other serious infections. In some situations, cefotaxime has been given in combination with another antibiotic such as an aminoglycoside, but the merits of such a combination have not been clearly established. Whether cefotaxime alone is appropriate therapy for conditions previously treated with aminoglycosides (other than pseudomonal infections) also needs additional clarification, but if established as equally effective in such conditions cefotaxime offers potentially important clinical and practical advantages in its apparent lack of serious adverse effects and freedom from the need to undertake drug plasma concentration monitoring.

Epidemiology and treatment of gonorrhoea caused by penicillinase-producing strains of Neisseria gonorrhoeae in Fukuoka, Japan

Thirty strains of penicillinase-producing Neisseria gonorrhoeae (PPNG) were detected by a rapid iodometric method out of 206 strains isolated from patients with gonorrhoea between January and December 1981. Of the 30 patients, five of the nine women were prostitutes and 14 of the 21 men were infected by prostitutes in or around Fukuoka City, with the exception of one who was infected in Formosa. Treatment with ampicillin or amoxycillin resulted in failure whereas treatment with spectinomycin was successful.

Ceftriaxone in the treatment of ordinary and penicillinase-producing strains of Neisseria gonorrhoeae

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.

Penicillinase-producing Neisseria gonorrhoeae in Great Britain, 1977-81: alarming increase in incidence and recent development of endemic transmission

Since penicillinase-producing Neisseria gonorrhoeae appeared five years ago in West Africa and South-east Asia reported cases have doubled annually in Great Britain, primarily as a result of increasing importation. Importation of penicillinase-producing Neisseria gonorrhoeae has increased exponentially because dramatic expansion of these strains in their regions of origin has led to increasing infection of male air travellers. From 1977 to 1980 infections acquired in Great Britain played only a minor part in the exponential increase. During 1981 the number of indigenous cases increased much more rapidly than imported cases, indicating that these strains have become truly endemic in Great Britain. Currently, identification of patients at high risk and initial treatment with penicillinase-resistant antibiotics offers the best hope of containing the strains. The emergence and rapid spread of penicillinase-producing Neisseria gonorrhoeae shows the international consequences of the abuse of antibiotics.

Penicillinase-producing Neisseria gonorrhoeae in Riyadh, Saudi Arabia

Of 83 strains of Neisseria gonorrhoeae isolated in Riyadh, Saudi Arabia, between April 1979 and August 1980, 10 produced beta-lactamase and had minimum inhibitory concentrations (MICs) of penicillin between 1 and greater than or equal to 4 micrograms/ml. Of the 73 (88%) non-penicillinase-producing strains, 55% had diminished sensitivity to penicillin (MIC = 0.06 micrograms/ml) and 11 (15%) were highly resistant (MICs ranging from 0.5-2 micrograms/ml). This high incidence of resistance may be due to widespread abuse of antibiotics; it also confirms that two mechanisms of resistance to penicillin exist in this species.

Susceptibility of Neisseria gonorrhoeae to cefotaxime and ceftizoxime

Two hundred and thirty-nine penicillinase-positive and 240 penicillinase-negative strains of Neisseria gonorrhoeae were tested for their susceptibility to cefotaxime. All were susceptible to cefotaxime at a concentration of 0.062 micrograms/ml. Penicillinase-negative strains were less susceptible than penicillinase-positive strains. This is attributed to the use of prophylactic antibiotics by prostitutes, which has led to the selection of less susceptible penicillinase-negative strains but has not affected the susceptibility of penicillinase-positive strains. The minimum inhibitory concentrations of cefotaxime showed significant positive correlations with those of penicillin, ampicillin, tetracycline, and kanamycin but had a negative correlation with spectinomycin. The related cephalosporin, ceftizoxime, was found to be as effective as cefotaxime against penicillinase-positive and penicillinase-negative gonococci.

Gentamicin in the treatment of infections due to penicillinase-producing gonococci

Ninety-seven patients with infections due to penicillinase-producing Neisseria gonorrhoeae (PPNG) were treated with single doses of gentamicin 280 mg intramuscularly. The failure rate among those followed up was 3%. No significant side effects were recorded. Gentamicin is a valuable alternative in the treatment of infections due to PPNG strains.