Single-dose treatment of uncomplicated gonorrhea: a comparison of cefonicid and penicillin

Cefonicid, a parenteral semisynthetic cephalosporin, achieves high and sustained serum levels in humans. Activity against strains of Neisseria gonorrhoeae, including those that produce beta-lactamase, has been shown in vitro. The efficacy of 1.0 g of cefonicid was evaluated noncomparatively in 50 men with gonococcal urethritis; four failed to respond to treatment. Additionally, 57 men and 34 women received either 1.0 g of cefonicid or 4.8 X 10(6) units of procaine penicillin G plus 1.0 g of probenecid in a double-blind study. Among 17 men treated with penicillin, two failed to respond, and one failed among the 33 patients treated with cefonicid. Seventeen women received 1.0 g of cefonicid, and all cervical infections were cured. Among those who received cefonicid, 13 had rectal infections; and four had positive cultures at follow-up four to seven days posttreatment. Among the 17 women receiving penicillin, none failed to respond to therapy; only seven had both cervical and rectal infection. Of the 116 pretreatment and seven posttreatment isolates tested, 45 (37%) were inhibited by less than 0.0625 microgram of penicillin/ml and 121 (98%) were inhibited by less than 1.0 microgram/ml. Forty-one (33%) of the 123 isolates were inhibited by less than 0.0625 microgram of cefonicid/ml and 122 (99%) by less than 1.0 microgram of cefonicid/ml. The median MIC of cefonicid for the strains isolated from the women whose rectal infections were cured was 0.125 microgram/ml; that for the strains isolated from the women with rectal infections who failed to respond was 0.5 microgram/ml. Administration of 1.0 g of cefonicid intramuscularly is effective therapy for uncomplicated gonococcal urethritis in men.(ABSTRACT TRUNCATED AT 250 WORDS)