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Two non-cephalosporin regimens effective against gonorrhea
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Combination treatments containing azithromycin and gentamicin or gemifloxacin were highly effective at treating urogenital gonorrhea, according to recent data.
“Cephalosporin resistance in Neisseria gonorrhoeae is expected to emerge and these combinations may be helpful for patients infected with ceftriaxone-resistant gonococci or patients with severe cephalosporin allergy,” Robert Kirkcaldy, MD, MPH, of the CDC’s Division of STD Prevention, and colleagues wrote in Clinical Infectious Diseases. “This trial provides much-needed data in the short term, but additional treatment options for gonorrhea are urgently needed.”
Robert Kirkcaldy
Men and women receiving treatment for uncomplicated urogenital gonorrhea at one of five STD clinics were enrolled in the trial from May 2010 to November 2012. The patients were randomly assigned to 240 mg gentamicin intramuscularly (or 5 mg/kg if ≤45 kg) plus 2 g oral azithromycin or 320 mg gemifloxacin and 2 g azithromycin, both given orally. Patients were to return in 10 to 17 days for evaluation.
The per-protocol analysis included 401 patients. All patients treated with the gentamicin/azithromycin combination and 99.5% of patients treated with the gemifloxacin/azithromycin achieved a microbiological cure. Twenty-five patients who also had pharyngeal gonorrhea and six patients who also had rectal gonorrhea achieved microbiological cure.
Gastrointestinal issues were the most common adverse events and were mild/moderate. There were no serious adverse events. In the gentamicin/azithromycin arm, 27.7% reported nausea, 18.8% reported diarrhea and 7.4% reported vomiting. In the gemifloxacin/azithromycin arm, 37.2% had nausea, 23.1% had diarrhea and 5% had vomiting.
“In 2013, CDC named N. gonorrhoeae as one of three ‘urgent’ antimicrobial threats,” the researchers wrote. “Additional gonorrhea treatment options are needed. Although these combinations exhibited excellent efficacy, the burden of adverse events is likely to limit the routine use of these combinations.”
Disclosure: The researchers report no relevant financial disclosures.
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