Treatment of uncomplicated gonorrhea with cefotaxime

Three hundred seventy-six patients with uncomplicated infection due to beta-lactamase-negative Neisseria gonorrhoeae were treated with 1.0 g of cefotaxime intramuscularly or with 4.8 x 10(6) units of aqueous procaine penicillin G (APPG) intramuscularly plus 1.0 g of probenecid, administered orally. Cefotaxime eradicated 157 (98.1%) of 160 urethral or endocervical gonococcal infections, 22 (96%) of 23 rectal infections, and 8 (73%) of 11 pharyngeal infections. In comparison, APPG-probenecid eradicated 125 (98.4%) of 127 urethral or endocervical gonococcal infections, 17 (94%) of 18 rectal infections, and 4 (100%) of 4 pharyngeal infections. Of 304 domestic beta-lactamase-negative gonococcal isolates, 294 (96.7%) were inhibited by less than or equal to 0.03 microgram/ml of cefotaxime. In a separate study, cefotaxime eradicated 31 of 31 urethral infections due to beta-lactamase-positive strains of N. gonorrhoeae acquired by U.S. Navy personnel in the Philippines. Treatment with cefotaxime was tolerated better than treatment with APPG, primarily because only one injection is required for cefotaxime. The efficacy of cefotaxime was comparable to that of APPG-probenecid in the treatment of uncomplicated genital or rectal infection due to beta-lactamase-negative N. gonorrhoeae, and cefotaxime appears to be highly effective for the treatment of urethral infection due to beta-lactamase-positive N. gonorrhoeae. Further studies are needed for assessment of the efficacy of cefotaxime for treatment of pharyngeal gonococcal infection.