Single-dose treatment of gonorrhoea with cotrimoxazole. A report on 1,223 cases.

Rahim, G. F.

doi:10.1136/sti.51.3.179

Cited by 7 publications

(3 citation statements)

References 7 publications

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“…23 Early studies evaluating co-trimoxazole used several different regimens, and cure rates varied from 66 to 100%; large doses and multi-day regimens had higher cure rates than single doses and treatment failures were associated with raised MICs. [24][25][26][27] In 1988, a study of 119 patients with pharyngeal gonorrhoea found cure rates of 97% with a five-day schedule and 89.8% with a two-day schedule. 28 Failure was seen with MICs ≥0.5 mg/L of trimethoprim and ≥9.5 mg/L sulfamethoxazole, 29 whereas cure was predictable when the isolates were inhibited by ≤0.63/11.87 mg/L of TMP/SMZ (fixed ratio, 1:19).…”

Section: Discussionmentioning

confidence: 99%

What’s left in the cupboard? Older antimicrobials for treating gonorrhoea

Fifer

Livermore

Uthayakumaran

et al. 2021

Journal of Antimicrobial Chemotherapy

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Background Neisseria gonorrhoeae has developed resistance to all antimicrobials used to treat gonorrhoea, with even ceftriaxone being undermined. It is therefore important to examine any potential to redeploy older antimicrobials routinely used for other infections to treat ceftriaxone-resistant gonococcal infections. Objectives We examined the susceptibility of N. gonorrhoeae to aztreonam, chloramphenicol, co-trimoxazole, fosfomycin, piperacillin/tazobactam and rifampicin. Methods N. gonorrhoeae isolates (n = 94) were selected to include a range of antimicrobial susceptibilities: 58 were collected in the Gonococcal Resistance to Antimicrobials Surveillance Programme; 17 were clinical isolates referred to the PHE reference laboratory; and 19 were control strains. MICs were determined by agar dilution for the six study antimicrobials and for ceftriaxone and azithromycin as comparators. Results There was correlation between piperacillin/tazobactam and ceftriaxone MICs, but all five isolates with high ceftriaxone MICs (>0.5 mg/L) were inhibited by piperacillin/tazobactam at 0.06–0.5 mg/L. Aztreonam MICs for ceftriaxone-resistant isolates exceeded those of ceftriaxone. Among non-β-lactams, fosfomycin and co-trimoxazole had low, tightly clustered MICs, suggesting widespread susceptibility, rifampicin split the collection into highly susceptible and highly resistant groups and chloramphenicol had a wide MIC distribution. Conclusions Although unsuitable for empirical use, piperacillin/tazobactam, fosfomycin, co-trimoxazole, rifampicin and, possibly, chloramphenicol could be considered for individual patients with ceftriaxone-resistant gonococcal infection once MICs are known. Wider surveillance of the susceptibility of N. gonorrhoeae to these agents is needed, along with clinical trials and the establishment of clinical breakpoints for N gonorrhoeae.

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Section: Discussionmentioning

confidence: 99%

What’s left in the cupboard? Older antimicrobials for treating gonorrhoea

Fifer

Livermore

Uthayakumaran

et al. 2021

Journal of Antimicrobial Chemotherapy

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“…Unfortunately, singledose treatments of gonorrhea with SMX:TMP have usually been disappointing. Although studies among populations harboring relatively susceptible strains of gonococci seemed promising (4,14,21), recent trials in the United States and elsewhere have been unsatisfactory. Treatment of men for acute uncomplicated anogenital gonorrhea with single doses of eight or nine tablets yields cure rates ranging from 70 to 80% (8.…”

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confidence: 99%

Sulfamethoxazole-trimethoprim synergism for Neisseria gonorrhoeae

Rein¹,

Elliott²,

Swenson³

et al. 1980

Antimicrob Agents Chemother

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Sulfamethoxazole and trimethoprim are synergistic against many bacteria in sulfamethoxazole/trimethoprim concentrations of 20:1, but single-dose therapy of gonorrhea with the combination is disappointing. We used agar dilution techniques to determine minimal inhibitory concentrations of sulfamethoxazole and trimethoprim for 168 gonococci isolated from men with acute urethritis in Atlanta, Ga. The geometric mean minimal inhibitory concentrations were 5.6 ,ug of sulfamethoxazole per ml and 24.3 ,tg of trimethoprim per ml, a ratio of 1:4. The concentration of sulfamethoxazole inhibiting 50% of gonococcal strains dropped only from 4.7 ,g/ml to 2.9 ,tg/ml with the addition of a 1/20 dilution of trimethoprim. We studied synergism with various ratios of sulfamethoxazole to trimethoprim against 20 random strains. A ratio of 1:1 was always synergistic and was the most synergistic ratio for 15 strains, whereas the 19:1 ratio was never the most synergistic. The 19:1 ratio failed to show synergism against seven strains, but showed antagonism at this ratio with five of these seven. The sulfamethoxazole/trimethoprim ratio of 19:1 usually achieved in serum after oral administration is minimally synergistic and is sometimes antagonistic for gonococci. Austin and colleagues tested 54 fresh isolates at two ratios of SMX/TMP and found that 1:3 was more synergistic than 20:1 (1). Stolz et al. found that a 1:1 ratio and a 1:20 ratio of SMX/TMP were more synergistic than the 20:1 ratio for 5 gonococcal isolates (23). Phillips and colleagues tested 30 strains and found that ratios of SMX/ TMP from 1:1 to 1:8 were generally more synergistic than ratios involving larger relative amounts of SMX (18). The ratio producing maximal synergy tended to be related to the ratio of the MICs of the individual drugs alone.We thought that the relatively low efficacy of single-dose SMX/TMP therapy for acute gonorrhea might result in part from a lack of synergism between the drugs. We determined the susceptibility to SMX and TMP of freshly isolated strains of N. gonorrhoeae and determined the synergistic effect of various combinations of the two drugs.

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“…Because of the apparent efficacy of relatively short-term, high-dose therapy with multidose regimens of TMP-SMZ and the desirability of using a single-dose regimen for the treatment of uncomplicated genitourinary gonorrhea, the efficacy of single doses consisting of 8 to 12 tablets has also been studied (4,7,9,10,13 (4,9,10,13) cure rates (83 to 96%) were lower than those observed after comparative multidose regimens using lower individual doses (9,10) and after eight tablets given twice (4). After nine tablets the cure rate was significantly lower than that achieved with 3.5 g of ampicillin plus 1.0 g of probenecid orally (69 versus 100%, P < 0.02; R. B.…”

mentioning

confidence: 99%

Pharmacokinetics and Tolerance of a Single Twelve-Tablet Dose of Trimethoprim (960 mg)-Sulfamethoxazole (4,800 mg)

Fass

Prior

Perkins

1977

Antimicrob Agents Chemother

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To evaluate the potential usefulness of a single large oral dose of trimethoprim-sulfamethoxazole (TMP-SMZ) for the treatment of uncomplicated genitourinary gonorrhea, the pharmacokinetics of a 12-tablet dose containing 960 mg of TMP and 4,800 mg of SMZ were studied in 15 male volunteers, and the tolerance of this regimen was compared to that of a placebo in a double-blind crossover study. Both TMP and SMZ were rapidly absorbed. Peak mean serum concentrations (± standard deviation) ofTMP, total SMZ, and free SMZ were 9.2 + 2.2, 259.4 ± 40.9, and 233.7 + 33.6 ,g/ml, respectively. Elimination half-lives were 16.7, 14.6, and 12.9 h, respectively. When results were compared to data from similar studies after smaller doses, peak mean serum concentrations were proportional to dose, but elimination half-lives were longer after larger doses. Urinary concentrations ofTMP, total SMZ, and free SMZ were many-fold higher than serum concentrations. Percents recovery (+ standard deviation) in urine were 60.6 + 10.6, 80.2 + 7.8, and 37.4 ± 6.5%, respectively, during the 48 h after administration. The incidence of severe headache and of objective transient oliguria was significantly higher after TMP-SMZ than after placebo. Although the observed serum concentrations of TMP and SMZ surpassed concentrations necessary to inhibit clinical isolates ofNeisseria gonorrhoeae in vitro for longer than 24 h, the adverse reactions associated with a 12-tablet dose of TMP-SMZ would preclude the clinical usefulness of such a therapeutic regimen.Multidose regimens of trimethoprim-sulfamethoxazole (TMP-SMZ) have been well tolerated but have had varying degrees of efficacy in the treatment of uncomplicated genitourinary gonorrhea. In studies (1,2,9,15,17) that compared various treatment regimens, using a total of 16 to 20 tablets (each containing 80 mg of TMP and 400 mg of SMZ), cure rates were consistently higher (92 to 100%) when four-to sixtablet doses were administered than were cure rates (80 to 95%) when one-to three-tablet doses were administered. The higher cure rates observed with the former were attributed to the presumably higher serum and tissue concentrations, which were achieved despite the smaller number of doses.Because of the apparent efficacy of relatively short-term, high-dose therapy with multidose regimens of TMP-SMZ and the desirability of using a single-dose regimen for the treatment of uncomplicated genitourinary gonorrhea, the efficacy of single doses consisting of 8 to 12 tablets has also been studied (4, 7, 9, 10, 13;

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Single-dose treatment of gonorrhoea with cotrimoxazole. A report on 1,223 cases.

Cited by 7 publications

References 7 publications

What’s left in the cupboard? Older antimicrobials for treating gonorrhoea

What’s left in the cupboard? Older antimicrobials for treating gonorrhoea

Sulfamethoxazole-trimethoprim synergism for Neisseria gonorrhoeae

Pharmacokinetics and Tolerance of a Single Twelve-Tablet Dose of Trimethoprim (960 mg)-Sulfamethoxazole (4,800 mg)

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