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. 1990 May;34(5):819–822. doi: 10.1128/aac.34.5.819

Oral ciprofloxacin versus ceftriaxone for the treatment of urethritis from resistant Neisseria gonorrhoeae in Zambia.

J P Bryan 1, S K Hira 1, W Brady 1, N Luo 1, C Mwale 1, G Mpoko 1, R Krieg 1, E Siwiwaliondo 1, C Reichart 1, C Waters 1, et al.
PMCID: PMC171698  PMID: 2113796

Abstract

Neisseria gonorrhoeae strains resistant to treatment with penicillin, tetracycline, and/or spectinomycin are increasing in prevalence in many parts of the world. In Zambia, 52% of N. gonorrhoeae isolates produced beta-lactamase in 1986. Few oral regimens have proven effective for treatment of resistant N. gonorrhoeae. We conducted a prospective, double-blind, randomized clinical trial of 250 mg of ciprofloxacin given orally versus 250 mg of ceftriaxone given intramuscularly for treatment of uncomplicated gonococcal urethritis in adult males. Two hundred men were enrolled and treated. The two groups were comparable in age (27.5 years), prevalence of latent syphilis (14 and 10%), and human immunodeficiency virus infection (32 and 38%). Of 165 patients with cultures positive for N. gonorrhoeae who returned for follow-up, ciprofloxacin cured 83 of 83 (100%), including 26 with penicillinase-producing N. gonorrhoeae (PPNG) and 21 with N. gonorrhoeae with chromosomally mediated resistance to multiple antibiotics (CMRNG), and ceftriaxone cured 81 of 82 (98.7%), including 30 with PPNG and 19 with CMRNG. Both treatment regimens were well tolerated. Chlamydia trachomatis in urethral exudate was found by direct fluorescent-antibody microscopic examination or by culture in 10 (5%) participants. All N. gonorrhoeae isolates were inhibited by ceftriaxone at 0.06 micrograms/ml, except one which was inhibited at 0.125 micrograms/ml, while ciprofloxacin inhibited all isolates at 0.03 micrograms/ml. Ciprofloxacin is a safe and effective therapy for uncomplicated gonococcal urethritis, including that caused by PPNG and CMRNG in human immunodeficiency virus-infected men.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Avonts D., Fransen L., Vielfont J., Stevens A., Hendrickx K., Piot P. Treating uncomplicated gonococcal infection with 250 mg or 100 mg ciprofloxacin in a single oral dose. Genitourin Med. 1988 Apr;64(2):134–134. doi: 10.1136/sti.64.2.134. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Aznar J., Prados R., Rodriguez-Pichardo A., Hernandez I., De Miguel C., Perea E. J. Comparative clinical efficacy of two different single-dose ciprofloxacin treatments for uncomplicated gonorrhea. Sex Transm Dis. 1986 Jul-Sep;13(3):169–171. doi: 10.1097/00007435-198607000-00012. [DOI] [PubMed] [Google Scholar]
  3. Bell T. A., Grayston J. T. Centers for Disease Control guidelines for prevention and control of Chlamydia trachomatis infections. Summary and Commentary. Ann Intern Med. 1986 Apr;104(4):524–526. doi: 10.7326/0003-4819-104-4-524. [DOI] [PubMed] [Google Scholar]
  4. Black J. R., Long J. M., Zwickl B. E., Ray B. S., Verdon M. S., Wetherby S., Hook E. W., 3rd, Handsfield H. H. Multicenter randomized study of single-dose ofloxacin versus amoxicillin-probenecid for treatment of uncomplicated gonococcal infection. Antimicrob Agents Chemother. 1989 Feb;33(2):167–170. doi: 10.1128/aac.33.2.167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bodhidatta L., Taylor D. N., Chitwarakorn A., Kuvanont K., Echeverria P. Evaluation of 500- and 1,000-mg doses of ciprofloxacin for the treatment of chancroid. Antimicrob Agents Chemother. 1988 May;32(5):723–725. doi: 10.1128/aac.32.5.723. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Boslego J. W., Hicks C. B., Greenup R., Thomas R. J., Wiener H. A., Ciak J., Tramont E. C. A prospective randomized trial of ofloxacin vs. doxycycline in the treatment of uncomplicated male urethritis. Sex Transm Dis. 1988 Oct-Dec;15(4):186–191. doi: 10.1097/00007435-198810000-00002. [DOI] [PubMed] [Google Scholar]
  7. Faruki H., Kohmescher R. N., McKinney W. P., Sparling P. F. A community-based outbreak of infection with penicillin-resistant Neisseria gonorrhoeae not producing penicillinase (chromosomally mediated resistance). N Engl J Med. 1985 Sep 5;313(10):607–611. doi: 10.1056/NEJM198509053131004. [DOI] [PubMed] [Google Scholar]
  8. Hook E. W., 3rd, Roddy R. E., Handsfield H. H. Ceftriaxone therapy for incubating and early syphilis. J Infect Dis. 1988 Oct;158(4):881–884. doi: 10.1093/infdis/158.4.881. [DOI] [PubMed] [Google Scholar]
  9. Hooper D. C., Wolfson J. S. Treatment of genitourinary tract infections with fluoroquinolones: clinical efficacy in genital infections and adverse effects. Antimicrob Agents Chemother. 1989 Oct;33(10):1662–1667. doi: 10.1128/aac.33.10.1662. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Jephcott A. E., Turner A. Ciprofloxacin resistance in gonococci. Lancet. 1990 Jan 20;335(8682):165–165. doi: 10.1016/0140-6736(90)90035-4. [DOI] [PubMed] [Google Scholar]
  11. Judson F. N. Management of antibiotic-resistant Neisseria gonorrhoeae. Ann Intern Med. 1989 Jan 1;110(1):5–7. doi: 10.7326/0003-4819-110-1-5. [DOI] [PubMed] [Google Scholar]
  12. Knapp J. S. Laboratory methods for the detection and phenotypic characterization of Neisseria gonorrhoeae strains resistant to antimicrobial agents. Sex Transm Dis. 1988 Oct-Dec;15(4):225–233. doi: 10.1097/00007435-198810000-00009. [DOI] [PubMed] [Google Scholar]
  13. Knapp J. S., Zenilman J. M., Biddle J. W., Perkins G. H., DeWitt W. E., Thomas M. L., Johnson S. R., Morse S. A. Frequency and distribution in the United States of strains of Neisseria gonorrhoeae with plasmid-mediated, high-level resistance to tetracycline. J Infect Dis. 1987 Apr;155(4):819–822. doi: 10.1093/infdis/155.4.819. [DOI] [PubMed] [Google Scholar]
  14. Kraus S. J., Reynolds G. H., Rolfs R. T., Jr Therapy of uncomplicated gonorrhea due to antibiotic-resistant Neisseria gonorrhoeae. Sex Transm Dis. 1988 Oct-Dec;15(4):234–243. doi: 10.1097/00007435-198810000-00010. [DOI] [PubMed] [Google Scholar]
  15. MacDonald K. S., Cameron D. W., D'Costa L., Ndinya-Achola J. O., Plummer F. A., Ronald A. R. Evaluation of fleroxacin (RO 23-6240) as single-oral-dose therapy of culture-proven chancroid in Nairobi, Kenya. Antimicrob Agents Chemother. 1989 May;33(5):612–614. doi: 10.1128/aac.33.5.612. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Meheus A., Widy-Wirski R., D'Costa J., Van Dyck E., Delgadillo R., Piot P. Treatment of gonorrhoea in males in the Central African Republic with spectinomycin and procaine penicillin. Bull World Health Organ. 1984;62(1):89–94. [PMC free article] [PubMed] [Google Scholar]
  17. Pabst K. M., Siegel N. A., Smith S., Black J. R., Handsfield H. H., Hook E. W., 3rd Multicenter, comparative study of enoxacin and ceftriaxone for treatment of uncomplicated gonorrhea. Sex Transm Dis. 1989 Jul-Sep;16(3):148–151. doi: 10.1097/00007435-198907000-00006. [DOI] [PubMed] [Google Scholar]
  18. Poitevin M., Ly M., Daubras M., Ichou F. Etude in vivo de la sensibilité de Treponema pallidum à l'ofloxacine. Pathol Biol (Paris) 1988 May;36(5):482–487. [PubMed] [Google Scholar]
  19. Roddy R. E., Handsfield H. H., Hook E. W., 3rd Comparative trial of single-dose ciprofloxacin and ampicillin plus probenecid for treatment of gonococcal urethritis in men. Antimicrob Agents Chemother. 1986 Aug;30(2):267–269. doi: 10.1128/aac.30.2.267. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Rothenberg R., Voigt R. Epidemiologic aspects of control of penicillinase-producing Neisseria gonorrhoeae. Sex Transm Dis. 1988 Oct-Dec;15(4):211–216. doi: 10.1097/00007435-198810000-00007. [DOI] [PubMed] [Google Scholar]
  21. Smith B. L., Cummings M., Benes S., Draft K., McCormack W. M. Evaluation of difloxacin in the treatment of uncomplicated urethral gonorrhea in men. Antimicrob Agents Chemother. 1989 Oct;33(10):1721–1723. doi: 10.1128/aac.33.10.1721. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Veller-Fornasa C., Tarantello M., Cipriani R., Guerra L., Peserico A. Effect of ofloxacin on Treponema pallidum in incubating experimental syphilis. Genitourin Med. 1987 Jun;63(3):214–214. doi: 10.1136/sti.63.3.214. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Wolfson J. S., Hooper D. C. Treatment of genitourinary tract infections with fluoroquinolones: activity in vitro, pharmacokinetics, and clinical efficacy in urinary tract infections and prostatitis. Antimicrob Agents Chemother. 1989 Oct;33(10):1655–1661. doi: 10.1128/aac.33.10.1655. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Zenilman J. M., Nims L. J., Menegus M. A., Nolte F., Knapp J. S. Spectinomycin-resistant gonococcal infections in the United States, 1985-1986. J Infect Dis. 1987 Dec;156(6):1002–1004. doi: 10.1093/infdis/156.6.1002. [DOI] [PubMed] [Google Scholar]

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