Treatment of gonorrhea: comparison of cefotaxime and penicillin

Simpson, Margaret; Khan, Mohammed Y.; Siddiqui, Yunus M.; Gruninger, R P; Wigren, D I

doi:10.1128/aac.19.5.798

Cited by 13 publications

(2 citation statements)

References 8 publications

(5 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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“…dose of cefotaxime was as effective as 4.8 x 10 6 U of procaine penicillin G in the treatment of uncomplicated gonorrhea. 119 A comparative study of cefotaxime versus clindamycin and gentamicin in the treatment of peritonitis (158 patients) and similar polymicrobial soft tissue surgical sepsis (91 patients) showed no significant difference between the two regimens. Infection was eliminated in 81 % of those treated with either antibiotic regimen, yet sepsis recurred in 6% of those treated with cefotaxime as compared to 13% of those given clindamycin/gentamicin.…”

Section: Comparative Clinical Trialsmentioning

confidence: 98%

Mechanism of Action, Antimicrobial Activity, Pharmacology, Adverse Effects, and Clinical Efficacy of Cefotaxime

LeFrock¹,

Prince

Left

1982

Pharmacotherapy

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Cefotaxime sodium, a parenteral cephalosporin antibiotic, exerts its bactericidal action through inhibition of bacterial cell wall synthesis. Chemical structure modifications have enabled this compound to be resistant to the action of Richmond I, III, IV, and V beta-lactamase enzymes. Excellent activity against many gram-negative bacilli, especially Enterobacteriaceae, has been demonstrated. Antipseudomonal activity is generally poor, however. Activity against gram-positive cocci, with the notable exception of Streptococcus fecalis, is adequate. Anaerobic activity is variable, particularly against Clostridia and Bacteroides species. Acute, subacute, and chronic toxicity studies in animals were generally unremarkable. No mutagenic effects or reproductive toxicity have been noted in animals. In man, cefotaxime is desacetylated to a microbiologically active metabolite. Urinary excretion is approximately 50-60% and 15-20% of a dose for the parent compound and desacetyl metabolite, respectively. The elimination half-life of cefotaxime is about one hour, with the total body clearance being approximately twice that of the renal clearance. Severe renal dysfunction causes a prolongation of the elimination half-life of cefotaxime and particularly desacetyl cefotaxime. A relatively low degree of protein binding in part attributes to a wide bodily distribution of cefotaxime. Cefotaxime is effective in a variety of infectious processes caused by susceptible organisms. Local reactions at the injection site and hypersensitivity phenomena are the most common adverse effects. Comparative trials attesting to cefotaxime's clinical utility over other parenteral cephalosporins or amino-glycosides are very limited. Based on the available evidence, cefotaxime should be most useful in combating serious gram-negative infections, because of its excellent activity against most of these organisms and its low toxicity profile.

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Sexually Transmitted Gastrointestinal Infections

Vellend

1986

Modern Concepts in Gastroenterology

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Treatment of gonorrhea: comparison of cefotaxime and penicillin

Cited by 13 publications

References 8 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

Mechanism of Action, Antimicrobial Activity, Pharmacology, Adverse Effects, and Clinical Efficacy of Cefotaxime

Sexually Transmitted Gastrointestinal Infections

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