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We studied the susceptibilities of 77 strains of Neisseria gonorrhoeae to four antibiotics: cefpodoxime, ceftriaxone, penicillin, and tetracycline. All strains were susceptible to ceftriaxone. Cefpodoxime MICs (range, 0.001 to 0.125 ,ug/ml) were parallel to and approximately four times those of ceftriaxone, and all strains will probably be considered susceptible to cefpodoxime. Disk diffusion zone diameters for cefpodoxime ranged from 35 to 57 mm. Of the strains, 32% were penicillin resistant and 51% were tetracycline resistant (MIC,.2 ,ug/ml). Susceptibility measurements were consistent for disk diffusion zone diameter and MIC, with an overall agreement of 215 of 225 (96%) for ceftriaxone, penicillin, and tetracycline combined. On the basis of these in vitro data, cefpodoxime should be evaluated in the treatment of gonorrhea.There are two major limitations in the current management of patients with gonorrhea. The first limitation is the shortage of effective antimicrobial agents which can be given in a single oral dose. Oral medications can improve acceptance of treatment, and single-dose therapy makes it unnecessary to rely on patient compliance to complete therapy at home. Quinolones (3) and cephalosporins (1) have both been useful in the oral treatment of gonorrhea. Tetracyclines (10) and penicillin (5), however, are no longer reliable therapeutic agents because of the emergence and dissemination of resistant strains of Neisseria gonorrhoeae.The second limitation is the exceptional difficulty in testing for antibiotic resistance in N. gonorrhoeae. Few clinical laboratories currently do more than test for P-lactamase production (7). The fastidious growth requirements of N. gonorrhoeae have precluded the use of the usual broth microdilution and disk diffusion technologies for routine susceptibility testing. Reference laboratories provide information about resistance patterns in different geographical regions, but this may be of limited value in treatment decisions made at the time of diagnosis.We studied the susceptibility of N. gonorrhoeae to cefpodoxime, a new oral cephalosporin. This agent is administered as cefpodoxime proxetil, an ester prodrug, which is metabolized to active drug (cefpodoxime) by intestinal esterases (13). Cefpodoxime is resistant to many bacterial P-lactamases and has an antimicrobial spectrum similar to that of cefixime but with greater activity for gram-positive organisms (9). In one in vitro study, cefpodoxime had activity superior to that of cefuroxime and comparable with that of ceftriaxone for N. gonorrhoeae (12). Cefpodoxime is well absorbed and well tolerated and has a plasma half-life of 2.7 h (2); after a single oral dose of 200 mg, levels in plasma exceed 1 ,ug/ml for more than 5 h.We compared susceptibility results for cefpodoxime, ceftriaxone, penicillin, and tetracycline. Ceftriaxone is currently the preferred therapy for the treatment of gonorrhea in the United States (4). A dose of 250 mg given intramuscularly is essentially 100% curative for gonorrhea infection of the a...

Pseudoepidemics due to common organisms are often difficult to detect, and delayed recognition can result in substantial morbidity. This outbreak investigation illustrates the potential for contamination of diluents in the microbiology laboratory and emphasizes the need for meticulous quality control.