Comparison of ceftriaxone with cefoxitin in the treatment of penicillin-resistant gonococcal urethritis.

Zajdowicz, Thaddeus; Sanches, Priscila L.; Berg, S. W.; Kerbs, Sharon; Newquist, R. L.; Harrison, William O.

doi:10.1136/sti.59.3.176

Cited by 24 publications

(9 citation statements)

References 8 publications

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“…Twenty-five studies used intramuscular injection monotherapy that involved 6422 patients and compared the efficacy of 12 different drugs . Nineteen of these studies reported adverse reactions in 569 patients and the safety of 11 drugs was assessed [28][29][30][31][32][33][34][35][37][38][39][40][41][42][45][46][47]50,51]. Similarly, 19 studies focused on oral monotherapy [52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71].…”

Section: Literature Search Process and Study Characteristicsmentioning

confidence: 99%

Efficacy and Safety of Injectable and Oral Antibiotics in Treating Gonorrhea: A Systematic Review and Network Meta-Analysis

Yang

Dhital

Naderer

2019

JCM

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Gonorrhea is the second most frequently reported sexually transmitted infectious disease of bacterial origin in the world. Current empiric therapies rely on broad-spectrum antibiotics. However, treatment options are becoming limited due to the rise of drug-resistant gonorrhea. To control the rise of drug-resistant gonorrhea and to identify alternative treatment options, clinicians will have to increasingly rely on experimental evidence for the treatment of gonorrhea patients. Thus, we performed a systematic review and network meta-analysis of all randomized clinical trials about the efficacy and safety of various antibiotic regimens in adults with gonorrhea. We searched all references in Embase and PubMed from the date of their inception to January 2019, and then an updated search was performed in March 2019. Of the 28,843 identified references, 44 fulfilled our selection criteria. We used a network meta-analysis based on a frequentist approach to evaluate the efficacy and safety of 12 injectable and 11 oral antibiotics. The efficacy of treatments was ranked by p score and inconsistency was assessed by a back-calculation method. Certainty of evidence was evaluated by the GRADE system. For injectable drugs, there was no difference in efficacy between a reference antibiotic and other drugs. However, ceftriaxone had significantly better efficacy than cefuroxime (OR, 12.03; cephaloridine (OR, 42.41; kanamycin (OR, 5.45; penicillin (OR, 13.11;, and spectinomycin (OR, 4.70; 95% CI 1.62-13.62). Thus, ceftriaxone was the most effective injectable drug (p score of 0.924). As for oral drugs, azithromycin was the most effective compound (p score of 0.8633). There were no significant differences in safety between injectable and oral treatments. In our systematic review of randomized controlled trials, we found azithromycin and ceftriaxone to be the most effective antibiotics for the treatment of gonorrhea. This is in line with current guidelines which recommend a combination therapy of azithromycin and ceftriaxone for the treatment of gonorrhea due to increased antimicrobial resistance. Our analysis identified gentamicin and ofloxacin as alternative therapeutics to treat drug-resistant gonorrhea.

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Section: Literature Search Process and Study Characteristicsmentioning

confidence: 99%

Efficacy and Safety of Injectable and Oral Antibiotics in Treating Gonorrhea: A Systematic Review and Network Meta-Analysis

Yang

Dhital

Naderer

2019

JCM

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“…Other parenteral cephalosporins have been studied and recommended as alternative regimens 8. These include ceftizoxime 500 mg IM,92-94 cefoxitin 2 gm IM with 1gm of probenecid,95-97 and cefotaxime 500mg IM 98-100. Cefuroxime 1.5gm IM is occasionally used in the United Kingdom.…”

Section: Cephalosporins For the Treatment Of Gonococcal Infectionsmentioning

confidence: 99%

The use of cephalosporins for gonorrhea: the impending problem of resistance

Barry

Klausner²

2009

Expert Opinion on Pharmacotherapy

149

118

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Gonorrhea remains an important clinical and public health problem throughout the world. Gonococcal infections have historically been diagnosed by Gram stain and culture, but are increasingly diagnosed through nucleic acid tests thereby eliminating the opportunity for antimicrobial susceptibility testing. Gonococcal infections are typically treated with single-dose therapy with an agent found to cure >95% of cases. Unfortunately, the gonococcus has repeatedly developed resistance to antimicrobials including sulfonamides, penicillin, tetracyclines, and fluoroquinolones. This has left third-generation cephalosporins as the lone class of antimicrobials currently recommended as first line therapy for gonorrhea in some regions. However, resistance to oral third-generation cephalosporins has emerged and spread in Asia, Australia and elsewhere. The mechanism of this resistance seems to be associated with a mosaic penicillin binding protein (penA) in addition to other chromosomal mutations previously found to confer resistance to beta-lactam antimicrobials (ponA, mtrR, penB, pilQ). Few good options exist or are in development for treating cephalosporin resistant isolates as most have had multidrug resistance. Preventing the spread of resistant isolates will depend on ambitious antimicrobial management programs, strengthening and expanding surveillance networks, and through effective sexually transmitted disease control and prevention.

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“…Cefotetan, the subject of this study, was such a compound that has demonstrated clinical success against gonorrhea (7,11,20). These features are shared with cefoxitin, a similar cephamycin compound (2,12,17,21).…”

Section: U>40mentioning

confidence: 93%

“…Susceptibility tests for cefoxitin, another cephamycin, against gonococci have recently been standardized by using GC agar base medium (9). These more simplified procedures should predict the favorable clinicalbacteriologic response to single-dose gonorrhea therapy, e.g., 2 g of cefoxitin plus a predose of 1 g of probenicid (9,12,17,21). Since cefotetan has superior pharmacokinetics compared with those of cefoxitin, probenicid is not required (16).…”

mentioning

confidence: 99%

Interpretive criteria and quality control guidelines for Neisseria gonorrhoeae susceptibility test standardization for cefotetan

et al. 1991

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Cefotetan was tested in a multilaboratory study to standardize susceptibility testing criteria and quality control guidelines for Neisseria gonorrhoeae. Cefotetan was most active against penicillinase-producing and penicillin-susceptible strains (MIC for 50% of strains tested, 0.5 ,ug/ml) and was least active against the chromosomally resistant isolates (MIC for 50% of strains tested, 2 ,ug/ml). The recommended 30-,ug disk cefotetan interpretive criteria were as follows: susceptible at .26 mm (c2 rig/ml), intermediate at 20 to 25 mm (4 ,ug/ml), and resistant at l19 mm (.8 ,Lg/ml). Quality control guidelines for agar dilution and disk diffusion tests were established by using numerous GC agar lots, three cefotetan 30-,ug disk lots, two quality control organisms, and a volume of tests consistent with National Committee for Clinical Laboratory Standards M23-T guidelines.

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Comparison of ceftriaxone with cefoxitin in the treatment of penicillin-resistant gonococcal urethritis.

Cited by 24 publications

References 8 publications

Efficacy and Safety of Injectable and Oral Antibiotics in Treating Gonorrhea: A Systematic Review and Network Meta-Analysis

Efficacy and Safety of Injectable and Oral Antibiotics in Treating Gonorrhea: A Systematic Review and Network Meta-Analysis

The use of cephalosporins for gonorrhea: the impending problem of resistance

Interpretive criteria and quality control guidelines for Neisseria gonorrhoeae susceptibility test standardization for cefotetan

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