The use of fluoroquinolones in sexually transmitted diseases in Southeast Asia

This paper reviews the use of the fluoroquinolone antibiotics in the management of sexually transmitted diseases (STD) in Southeast Asia. Numerous clinical trials performed in the region have shown that the quinolones are highly effective for treating uncomplicated gonorrhoea. Norfloxacin 800 mg, ofloxacin 400 mg, ciprofloxacin 250 mg, and pefloxacin 400 mg in single oral doses have yielded excellent clinical results. Overall cure rates were greater than 95%, with full eradication of penicillinase-producing Neisseria gonorrhoeae in all studies. Strains of gonococci resistant to the quinolones have already emerged and should be closely monitored. However, this has not become a serious problem to date, as large scale evaluation has shown that the quinolones remain highly efficacious for the treatment of gonorrhoea. These antibiotics in single doses are not effective for postgonococcal urethritis (PGU); therefore, concomitant use of an antichlamydial regimen for all patients with gonorrhoea is recommended. The quinolones are also highly effective for chancroid. Excellent results, with cure rates approaching 100%, were achieved with single oral doses of ciprofloxacin 500 mg, norfloxacin 800 mg, and ofloxacin 400 mg. Widespread use of these drugs in STD treatment regimens may be one of the main factors causing a dramatic decline in the number of cases of chancroid seen in recent years. Ofloxacin in variable dosages for a period of 10 to 21 days was found to be effective in nongonococcal urethritis (NGU). However, when compared with the tetracyclines, it is less cost effective and can thus be regarded as an alternative treatment for NGU.