Randomised comparative study of ceftriaxone and spectinomycin in gonorrhoea.

Panikabutra, Kanchana; Ariyarit, C; Chitwarakorn, Anupong; Saensanoh, C; Wongba, Chainarong

doi:10.1136/sti.61.2.106

Cited by 11 publications

(5 citation statements)

References 14 publications

(2 reference statements)

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“…Twenty-five studies used intramuscular injection monotherapy that involved 6422 patients and compared the efficacy of 12 different drugs . Nineteen of these studies reported adverse reactions in 569 patients and the safety of 11 drugs was assessed [27][28][29][30][31][32][33][34][36][37][38][39][40][41][44][45][46]49,50]. Similarly, 19 studies focused on oral monotherapy [51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70].…”

Section: Literature Search Process and Study Characteristicsmentioning

confidence: 99%

Efficacy and Safety of Injectable and Oral Antibiotics in Treating Gonorrhea: A Systematic Review and Network Meta-Analysis

Yang

Dhital

Naderer

2019

JCM

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Gonorrhea is the second most frequently reported sexually transmitted infectious disease of bacterial origin in the world. Current empiric therapies rely on broad-spectrum antibiotics. However, treatment options are becoming limited due to the rise of drug-resistant gonorrhea. To control the rise of drug-resistant gonorrhea and to identify alternative treatment options, clinicians will have to increasingly rely on experimental evidence for the treatment of gonorrhea patients. Thus, we performed a systematic review and network meta-analysis of all randomized clinical trials about the efficacy and safety of various antibiotic regimens in adults with gonorrhea. We searched all references in Embase and PubMed from the date of their inception to January 2019, and then an updated search was performed in March 2019. Of the 28,843 identified references, 44 fulfilled our selection criteria. We used a network meta-analysis based on a frequentist approach to evaluate the efficacy and safety of 12 injectable and 11 oral antibiotics. The efficacy of treatments was ranked by p score and inconsistency was assessed by a back-calculation method. Certainty of evidence was evaluated by the GRADE system. For injectable drugs, there was no difference in efficacy between a reference antibiotic and other drugs. However, ceftriaxone had significantly better efficacy than cefuroxime (OR, 12.03; cephaloridine (OR, 42.41; kanamycin (OR, 5.45; penicillin (OR, 13.11;, and spectinomycin (OR, 4.70; 95% CI 1.62-13.62). Thus, ceftriaxone was the most effective injectable drug (p score of 0.924). As for oral drugs, azithromycin was the most effective compound (p score of 0.8633). There were no significant differences in safety between injectable and oral treatments. In our systematic review of randomized controlled trials, we found azithromycin and ceftriaxone to be the most effective antibiotics for the treatment of gonorrhea. This is in line with current guidelines which recommend a combination therapy of azithromycin and ceftriaxone for the treatment of gonorrhea due to increased antimicrobial resistance. Our analysis identified gentamicin and ofloxacin as alternative therapeutics to treat drug-resistant gonorrhea.

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Section: Literature Search Process and Study Characteristicsmentioning

confidence: 99%

Efficacy and Safety of Injectable and Oral Antibiotics in Treating Gonorrhea: A Systematic Review and Network Meta-Analysis

Yang

Dhital

Naderer

2019

JCM

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“…No important laboratory abnormalities were noted. Panikabutra et al 63 Males; age limit not specified Ceftriaxone 250 mg IM Spectinomycin 2 g IM Ceftriaxone: 97 Spectinomycin: 93 Ceftriaxone: 100% Spectinomycin: 100% No adverse effects to either treatment were noted. Dixon et al 64 Males and females; age limit not specified Ceftriaxone 250 mg or 500 mg IM Procaine penicillin G 1.5 g plus Benzylpenicillin 300 mg IM Ceftriaxone: 107 Procaine penicillin G plus Benzylpenicillin: 115 Ceftriaxone: 100% Procaine penicillin G plus Benzylpenicillin: 90–100% (across four experimental groups) Mild injection pain was noted by an unreported number of patients.…”

Section: Evidence Of Efficacymentioning

confidence: 99%

“…Table 1 includes efficacy results from randomized, controlled clinical trials. [59][60][61][62][63][64][65][66][67] All studies used microbiologic eradication as the primary outcome and indicator of cure. Some studies included only anogenital infections, but others included individuals with oropharyngeal infection.…”

Section: Evidence Of Efficacymentioning

confidence: 99%

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Safety Aspects and Rational Use of Single Intramuscular Dose Ceftriaxone: Clinical Insights on the Management of Uncomplicated Gonococcal Infections

Allen,

Morrill

2023

DHPS

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Gonorrhea, a sexually transmitted infection caused by Neisseria gonorrhoeae , is a grave public health concern. Gonorrhea is the second most reported sexually transmitted infection worldwide. The treatment of uncomplicated gonococcal infections has evolved dramatically in response to the emergence of antimicrobial resistance. Multiple resistance mechanisms (for example, beta-lactamase production, antimicrobial efflux, and target site modification) exist, some of which may cause multidrug-resistance. Ceftriaxone was first recommended as an option for uncomplicated gonococcal infections in 1985, and it is now a mainstay of therapy in all clinical practice guidelines. Ceftriaxone has consistently shown high microbiologic cure rates in clinical trials, and it has demonstrated an excellent safety profile. Although its use may be limited in patients with hypersensitivity to penicillins, the risk of using ceftriaxone in such patients is overestimated. The emergence of reduced ceftriaxone susceptibility in N. gonorrhoeae , coupled with a lack of diverse treatment alternatives and the limited pipeline of new antimicrobials, is a significant threat to the treatment of gonorrhea.

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“…In the USA, cephalosporins are widely used to treat gonorrhoea and the CDC recommend ceftriaxone to treat uncomplicated gonorrhoea's, A single intramuscular dose of 250 mg is the most commonly used regimen and clinical trials of ceftriaxone in south-east Asia demonstrate a cure rate approaching 100% 36 …”

Section: Gonorrhoeamentioning

confidence: 99%

Antibiotic Chemotherapy of Bacterial Sexually Transmitted Diseases in Adults: A Review

Corcoran

Ridgway

1994

Int J STD AIDS

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Treatment regimens for sexually transmitted infections continue to evolve. The natural history of syphilis in HIV-infected patients is leading to more aggressive policies in terms of both investigation and treatment. In particular, treatment protocols for late syphilis, especially neurosyphilis, are under scrutiny. Epidemiological change typified by the spread of penicillinase-producing Neisseria gonorrhoeae (PPNG) has led to a search for new agents to treat gonorrhoea, with a more extensive use of cephalosporin and quinolone antibiotics emerging. The problem of compliance with the antibiotic courses presently required for chlamydial infection may be close to being solved with the development of newer macrolide agents. Single dose azithromycin, although expensive, seems to be as effective as longer courses with other agents. Furthermore, its efficacy in gonococcal infection is also encouraging. Increased understanding of the pathogenesis and natural history of pelvic inflammatory disease (PID) and bacterial vaginosis (BV) has led to rationalization of treatment policies for these conditions.

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Randomised comparative study of ceftriaxone and spectinomycin in gonorrhoea.

Cited by 11 publications

References 14 publications

Efficacy and Safety of Injectable and Oral Antibiotics in Treating Gonorrhea: A Systematic Review and Network Meta-Analysis

Efficacy and Safety of Injectable and Oral Antibiotics in Treating Gonorrhea: A Systematic Review and Network Meta-Analysis

Safety Aspects and Rational Use of Single Intramuscular Dose Ceftriaxone: Clinical Insights on the Management of Uncomplicated Gonococcal Infections

Antibiotic Chemotherapy of Bacterial Sexually Transmitted Diseases in Adults: A Review

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