Treatment of uncomplicated gonorrhea with cefotaxime

Patients with uncomplicated gonorrhea due to beta-lactamase-negative Neisseria gonorrhoeae were treated with cefotaxime (1.0 g given im in a single dose) or with aqueous procaine penicillin G (APPG; 4.8 x 10(6) units given im) plus probenecid (1.0 g given orally). Genital or rectal gonococcal infection was cured in 51 (93%) of 55 patients given cefotaxime and in 23 (96%) of 24 patients given APPG plus probenecid. Gonococcal isolates from homosexual men were less susceptible to cefotaxime (geometric mean MIC, 0.021 microgram/ml) than were strains isolated from heterosexual men (geometric mean MIC, 0.012 microgram/ml; P less than 0.05). Genital infection with Chlamydia trachomatis persisted in four of eight patients given cefotaxime and was first detected after treatment in three others. Of 23 men with gonococcal urethritis who were treated with cefotaxime and followed for 11--30 days, ten (43%) developed postgonococcal urethritis; five of these were associated with chlamydial infection. Administration of cefotaxime or APPG caused equal pain, but cefotaxime was better tolerated because of the need for only one injection. Cefotaxime and APPG plus probenecid are comparable for treatment of uncomplicated genital and rectal infection with beta-lactamase-negative N. gonorrhoeae.