Treatment of uncomplicated gonorrhea with single doses of 200 mg cefixime

Single-dose cefixime 400 mg orally is effective in the treatment of uncomplicated gonorrhea. However, lower doses of cefixime have not been studied, and the minimum effective single-dose regimen may risk selecting resistant strains of Neisseria gonorrhoeae. Therefore, we studied the efficacy of a lower dose of cefixime.

To assess the efficacy of 200 mg cefixime in the treatment of uncomplicated gonorrhea.

One hundred twenty-five patients (106 men, 19 women) with presumptive gonorrhea were treated with single doses of cefixime 200 mg orally in an open non-comparative study. Follow-up visits were scheduled for four to seven days after treatment.

Genital and rectal gonorrhea were eradicated in 93 (95%, CI95 90.5-99.2%) of 98 patients who were culture-positive at enrollment and returned for follow-up. Treatment was effective in 78 (95%) of 82 men with urethral infection and 15 (94%) of 16 women with anogenital infection. Two of three pharyngeal infections also were eradicated. Persistent infection was not associated with resistance to cefixime, penicillin, or tetracycline.

Cefixime 200 mg in a single dose has substantial efficacy in the treatment of uncomplicated gonorrhea, enhancing confidence that use of 400 mg cefixime for gonorrhea has a low risk of selecting gonococci with clinically significant antibiotic resistance. However, the 200 mg dose should not be used for routine treatment.