The Chemotherapy of Gonococcic Infections

Slyke, C. J. Van; Wolcott, Rolla R.; Mahoney, John F.

doi:10.1001/jama.1941.02820040010004

Cited by 8 publications

(2 citation statements)

References 4 publications

(6 reference statements)

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“…In 1935, Gerhard Domagk discovered sulfanilamide (59,63). The sulfonamides were the first antimicrobials used for treatment of gonorrhea; sulfanilamide initially cured 80 to 90% of gonorrhoea cases (74)(75)(76). Sulfapyridine became available in 1940 to 1941, and a 1-week course of sulfapyridine could cure many cases where sulfanilamide had failed (77).…”

Section: The Antimicrobial Eramentioning

confidence: 99%

“…Sulfapyridine became available in 1940 to 1941, and a 1-week course of sulfapyridine could cure many cases where sulfanilamide had failed (77). The subsequent drug sulfathiazol was as effective as sulfapyridine but was more tolerable (76,78). Unfortunately, by 1944, many gonococcal strains showed clinical resistance, and by the late 1940s, Ͼ90% of gonococcal isolates were resistant to sulfonamides in vitro (75,79).…”

Section: The Antimicrobial Eramentioning

confidence: 99%

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Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

2014

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SUMMARY Neisseria gonorrhoeae is evolving into a superbug with resistance to previously and currently recommended antimicrobials for treatment of gonorrhea, which is a major public health concern globally. Given the global nature of gonorrhea, the high rate of usage of antimicrobials, suboptimal control and monitoring of antimicrobial resistance (AMR) and treatment failures, slow update of treatment guidelines in most geographical settings, and the extraordinary capacity of the gonococci to develop and retain AMR, it is likely that the global problem of gonococcal AMR will worsen in the foreseeable future and that the severe complications of gonorrhea will emerge as a silent epidemic. By understanding the evolution, emergence, and spread of AMR in N. gonorrhoeae , including its molecular and phenotypic mechanisms, resistance to antimicrobials used clinically can be anticipated, future methods for genetic testing for AMR might permit region-specific and tailor-made antimicrobial therapy, and the design of novel antimicrobials to circumvent the resistance problems can be undertaken more rationally. This review focuses on the history and evolution of gonorrhea treatment regimens and emerging resistance to them, on genetic and phenotypic determinants of gonococcal resistance to previously and currently recommended antimicrobials, including biological costs or benefits; and on crucial actions and future advances necessary to detect and treat resistant gonococcal strains and, ultimately, retain gonorrhea as a treatable infection.

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Section: The Antimicrobial Eramentioning

confidence: 99%

Section: The Antimicrobial Eramentioning

confidence: 99%

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

2014

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Sulfathiazole in the Treatment of Gonorrhea in Women

Fletcher¹,

Gibson²,

Sulkin³

1941

JAMA

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tion. For example, his group of so-called untreated patients were handled quite differently from an "untreated group" in the usual sense. These patients were hospitalized under hygienic surroundings and were examined, cleansed and cultured fre¬ quently. I have always stressed the value of simple vaginal invasion with distention of crypts in the interest of drainage, incidental to the use of estrogenic suppositories and medicated ointment. There is a mechanical factor of importance here; therefore these children in ideal surroundings, treated weekly or semiweekly by vaginal manipulation, are not typical of a group left entirely alone, and we must not allow any one to suppose that we must not use the strictest precautions in relation to cross infection. In relation to infection from toilet seats, I have this to say: Six children with gonococcic infections, doubtless ordinarily cleansed, were passed on and off a toilet seat; then cultures of the toilet seat were carefully taken, and in only one instance were isolated colonies of Neisseria found. Uninfected children were not infected by the use of these seats.I think it has been proved that the culture material available to date is unsatisfactory. It seems likely, then, that culture may be at fault here. Also whereas six children might be exposed safely to such tests, the seventh or the seventieth might be the unfortunate victim. In any event, I don't believe we can dispense with all these precautions. I don't agree that institutionalization is not dangerous from several angles. I am certain that there is a danger in foundling home care. As for hos¬ pitalization in general, I admit that, save in exceptional cir¬ cumstances, it is unsatisfactory from both a practical and a psychologic point of view.Dr. Haven Emerson, New York: Twenty-six years ago Dr. William H. Park made a study of the bacteriology of toilet seats in schools in which children with gonococcic vaginitis had been found, and he never found any such organism on the toilet seats. That was done in numerous schools in Brooklyn and Manhattan with the thoroughness and controls characteristic of the work of Dr. Park. We must recognize that one of the most valuable results of specific chemotherapy is the abbrevia¬ tion of the period of communicability. If a child's period of communicability can be reduced from twenty-six or twenty-eight weeks to one week, a great gain has been accomplished in con¬ trol of the disease. The risk of careless handling in an insti¬ tution for children or orphan home is of a different order from what is found in a hospital. The hospital is operated on the basis of a medical aseptic technic. I should be inclined to suggest that we do not change the sanitary code of the city of New York with regard to the exclusion of children with purulent vaginal discharges from any nurseries, not because we believe the association of those children in a hospital would lead to infection but because of obvious risks of infection where less exact and careful measures for bacterial cleanliness are observ...

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The Chemotherapy of Gonorrheal Urethritis in the Male

Brömme¹

1941

JAMA

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medication was changed to sulfacetimide she had none. Three patients could not tolerate either sulfanilamide or sulfathiazole but had no ill effects from sulfacetimide. Seven patients with acute pyelonephritis of pregnancy were treated. All were given an eight day course of 30 tablets (15 Gm.). In each case the urine became sterile three days after treatment was started, and after the course was finished the patients required no repeti¬ tion of sulfacetimide. Chills, fever and pain disappeared immediately after the first day. Repeat stains of urinary sediment have all been negative, and deliveries have been uncomplicated. Two other patients treated post partum, and 1 after cesarean section, recovered.Three children are included in this series. One child aged 5 years had been treated with mandelates, sulfanil¬ amide and intramuscular azosulfamide with no reduc¬ tion of the temperature nor elimination of the chills and fever. A dose of 0.25 Gm. of sulfacetimide was given twice a day for two days, and the course was completed with 0.25 Gm. once a day for five days. The chills, fever and costovertebral pain disappeared on the third day. The urine became sterile-after hav¬ ing had many pus cells and gram-negative bacilli for four months-and remained sterile on repeated exami¬ nations over a period of nine consecutive months. Two patients, each 10 years of age, recovered from acute attacks of infection of the lower part of the urinary tract with the administration of sulfacetimide and have been without symptoms for eight months.In this group of 200 patients we found that 21 had been on sulfanilamide before sulfacetimide was given. Sulfanilamide was discontinued, either because of no response to the drug or because of reactions. After treatment with sulfacetimide, 17 patients were classed as recovered, 3 showed improvement and 1 did not respond. This is an 80.9 per cent improvement over sulfanilamide. Eleven patients who did not respond to the mandelates recovered with sulfacetimide, while 4 did not respond-a 73.3 per cent improvement over the mandelates. Three patients who did not respond to azosulfamide recovered on sulfacetimide therapy. Table 5.-Summary Number Per Cent Total number oí cases. 200 100.0 Recovered. . 171 85.5 Improved". 25 12.5 Unimproved. 4 2.0 Reactions. 8 4.0Six patients had previous sulfathiazole therapy : 2 could not tolerate it and 4 did not respond to it. These 6 patients recovered when placed on sulfacetimide therapy. Nine other patients who had taken some other form of oral therapy without response recovered when placed on sulfacetimide therapy. SUMMARY Two hundred cases of bacillary infection of the uri¬ nary tract were treated with sulfacetimide. The per¬ centage of recoveries was 85.5; 12.5 per cent showed improvement and 2 per cent showed no response to the drug.Sulfacetimide has been more effective in the treat¬ ment of these infections of the urinary tract than has sulfanilamide and the mandelates. In 80.9 per cent of the sulfanilamide-resistant cases recovery occurred when sulfacetimide...

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The Chemotherapy of Gonococcic Infections

Cited by 8 publications

References 4 publications

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

Sulfathiazole in the Treatment of Gonorrhea in Women

The Chemotherapy of Gonorrheal Urethritis in the Male

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