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Treatment of gonorrhea with trimethoprim-sulfamethoxazole
Abstract:
The following regimens were randomly administered to 271 men with gonococcal urethritis: 4.8 X 10(6) units of aqueous procaine penicillin G intramuscularly plus 1 g of probenecid orally (APPG); nine tablets of trimethoprim-sulfamethoxazole (TMP-SMZ; 720 mg of TMP and 3,600 mg of SMZ), orally as a single dose (TMP-SMZ-9); and 12 tablets of TMP-SMZ (960 mg of TMP and 4,800 mg of SMZ) orally as two doses of six tablets taken at a 6-hr interval (TMP-SMZ-12). The failure rates of the APPG, TMP-SMZ-9, and TMP-SMZ-12 regimens were 4%, 23%, and 19%, respectively. APPG was significantly more effective (P less than 0.05) than TMP-SMZ-9 or TMP-SMZ-12. Isolates of Neisseria gonorrhoeae from treatment failures as compared to those from treatment successes were significantly more resistant to SMZ (P less than 0.01) and to the TMP-SMZ combination in a ratio of 19 parts SMZ to one part TMP (P less than 0.05). Minimal inhibitory concentrations of SMZ, TMP, TMP-SMZ, and penicillin G showed positive correlation coefficients.
Insights
Aqueous procaine penicillin G (APPG) was the most effective treatment for gonococcal urethritis, outperforming trimethoprim-sulfamethoxazole (TMP-SMZ) regimens. Treatment failures were linked to increased resistance to TMP-SMZ in Neisseria gonorrhoeae.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Gonococcal urethritis remains a significant public health concern.
- Antimicrobial resistance in Neisseria gonorrhoeae necessitates evaluating treatment efficacy.
- Penicillin and trimethoprim-sulfamethoxazole are established treatment options.
Purpose of the Study:
- To compare the efficacy of aqueous procaine penicillin G (APPG) with two different regimens of trimethoprim-sulfamethoxazole (TMP-SMZ) for treating gonococcal urethritis.
- To investigate the relationship between antimicrobial resistance and treatment outcomes.
Main Methods:
- A randomized trial involving 271 men diagnosed with gonococcal urethritis.
- Administration of three treatment regimens: APPG (intramuscular penicillin G plus oral probenecid), TMP-SMZ-9 (single oral dose), and TMP-SMZ-12 (divided oral dose).
- Analysis of treatment failure rates and antimicrobial susceptibility testing of Neisseria gonorrhoeae isolates.
Main Results:
- APPG demonstrated a significantly lower failure rate (4%) compared to TMP-SMZ-9 (23%) and TMP-SMZ-12 (19%).
- Isolates from treatment failures showed significantly higher resistance to sulfamethoxazole (SMZ) and the TMP-SMZ combination.
- Positive correlations were observed between minimal inhibitory concentrations of SMZ, TMP, TMP-SMZ, and penicillin G.
Conclusions:
- APPG is a more effective treatment for gonococcal urethritis than the evaluated TMP-SMZ regimens.
- Increased resistance to TMP-SMZ in Neisseria gonorrhoeae contributes to treatment failures.
- Antimicrobial susceptibility testing is crucial for guiding effective gonorrhea treatment strategies.