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

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 ,-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. Chiamydia 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 ,ug/ml, except one which was inhibited at 0.125 ,ug/ml, while ciprofloxacin inhibited all isolates at 0.03 ,ug/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.

Antimicrobial susceptibility testing of Neisseria gonorrhoeae and implications for epidemiology and therapy

“…(38). A large clinical study conducted in Africa showed that treatment of 83 adult men with ciprofloxacin (a single, oral 250-mg dose) was 100% effective (11). The success rate for ceftriaxone was 98.7%.…”

DNA gyrase mutations in quinolone-resistant clinical isolates of Neisseria gonorrhoeae

“…These drugs have been demonstrated to be effective in treating gonococcal urethritis (1). However, treatment failure has been reported (3), and an increase in the number of clinical isolates of N. gonorrheae resistant to quinolones has been demonstrated (8,12).…”

Emergence of fluoroquinolone-resistant Neisseria gonorrhoeae in São Paulo, Brazil

“…Fluoroquinolones, such as ciprofloxacin or ofloxacin, are highly effective as an oral single-dose treatment for uncomplicated infections caused by gonococci strains, including those with previously documented types of resistance (3,6).…”