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Effectiveness of aztreonam, a new monobactam antibiotic, against penicillin-resistant gonococci
Abstract:
Since the recognition of penicillinase-producing strains of N gonorrhoeae (PPNG) in 1976, these organisms have attained a worldwide distribution. The treatment of choice for infection due to PPNG has generally been spectinomycin administered im. In 1981, however, an infection from California was reported to be due to a strain of PPNG that was also resistant to spectinomycin (MIC, greater than 2,048 micrograms/ml) [1]. Throughout 1982, seven such isolates were reported worldwide [2], and in January 1983 an epidemiologically linked series of 27 cases of infection due to spectinomycin-resistant PPNG occurred in Korea. Because of the apparent declining utility of spectinomycin, we studied the efficacy and safety of aztreonam, a synthetic monobactam antibiotic from the Squibb Institute for Medical Research (Princeton, NJ) [3], in the treatment of acute uncomplicated gonococcal urethritis in men. Men with gonococcal urethritis were randomly treated with either 1 g of aztreonam or 2 g of spectinomycin im. Of the 112 men so treated, 93 could ultimately be evaluated: 51 who received aztreonam and 42 who received spectinomycin. Both drugs were 100% effective in the treatment of urethritis produced by both penicillin-sensitive and penicillin-resistant strains of gonococci. Furthermore, there were no reported side effects in either group and no laboratory abnormalities attributable to the aztreonam, with the exception of one patient with a minimally elevated level of serum glutamic oxaloacetic transaminase (serum glutamic pyruvic transaminase and alkaline phosphatase levels were normal).(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Aztreonam and spectinomycin are both effective treatments for uncomplicated gonococcal urethritis. This study found aztreonam to be a safe and effective alternative to spectinomycin, especially with rising antibiotic resistance.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Penicillinase-producing Neisseria gonorrhoeae (PPNG) strains are globally distributed.
- Increasing resistance to spectinomycin necessitates alternative treatments for gonorrhea.
- Spectinomycin was the primary treatment for PPNG infections.
Purpose of the Study:
- To evaluate the efficacy and safety of aztreonam for treating uncomplicated gonococcal urethritis in men.
- To compare aztreonam with spectinomycin in a randomized trial.
- To address the declining utility of spectinomycin due to emerging resistance.
Main Methods:
- Randomized controlled trial comparing aztreonam and spectinomycin.
- Participants were men with acute uncomplicated gonococcal urethritis.
- Treatment involved intramuscular injections of either 1g aztreonam or 2g spectinomycin.
Main Results:
- Both aztreonam and spectinomycin demonstrated 100% efficacy against both penicillin-sensitive and resistant Neisseria gonorrhoeae strains.
- No significant side effects were reported for either treatment group.
- One patient receiving aztreonam had a minimally elevated serum glutamic oxaloacetic transaminase level, with other liver enzymes remaining normal.
Conclusions:
- Aztreonam is a safe and effective alternative for treating uncomplicated gonococcal urethritis.
- The study supports aztreonam's utility in managing gonorrhea, particularly in the context of rising antibiotic resistance.
- Both drugs were equally effective and well-tolerated in the evaluated patient population.