Randomized Trial of Trovafloxacin and Ofloxacin for Single-Dose Therapy of Gonorrhea

Jones, Robert B.; Schwebke, Jane R.; Thorpe, Edwin M.; Dalu, Z.A.; Leone, Peter A.; Johnson, Raymond B.

doi:10.1016/s0002-9343(97)00277-5

Cited by 14 publications

(8 citation statements)

References 11 publications

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“…For treatment of uncomplicated gonorrhea, sparfloxacin (200 mg), grepafloxacin (400 mg), and trovafloxacin (100 mg) have all been shown to be highly effective, when given as single doses, in eradicating N. gonorrhoeae [47][48][49]. Small numbers of rectal and pharyngeal infections were also eradicated by grepafloxacin and trovafloxacin.…”

Section: Clinical Applicationsmentioning

confidence: 99%

New Uses for New and Old Quinolones and the Challenge of Resistance

Hooper¹

2000

Clinical Infectious Diseases

151

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More than a decade ago ciprofloxacin, the first quinolone with broad indications, was released for clinical use in the United States. The release of ofloxacin, which also had broad applications, followed not long thereafter. Since that time there has been extensive use of these 2 agents and more limited use of other quinolones, such as norfloxacin, enoxacin, and lomefloxacin, which were limited to treatment of infections of the genitourinary tract. Applications of these quinolones largely employed their potent activities against gram-negative bacteria [1,2].This article focuses on information developed in the past 4 years on the 4 most recently released quinolones-levofloxacin, sparfloxacin, grepafloxacin, and trovafloxacin [3-8]-and their spectrum of activity, pharmacokinetics, tolerability, and clinical applications. It also focuses on new applications of the older quinolones. Issues of quinolone resistance related to expanding uses of quinolones will also be discussed. Spectrum of ActivityThe newer fluoroquinolones have retained much of the activity of ciprofloxacin and ofloxacin against enteric gramnegative bacteria, but none is more potent than ciprofloxacin against these pathogens or against Pseudomonas aeruginosa. Levofloxacin is the active stereoisomer of the racemic mixture of the 2 stereoisomers that make up ofloxacin and thus is generally 2-fold more potent than ofloxacin [3]. Trovafloxacin [9] and, to a lesser extent, levofloxacin generally have gram-negative coverage similar to that of ciprofloxacin, but both may be less active against some strains of P. aeruginosa.There may also be gaps in trovafloxacin's coverage of some strains of Providencia species, Proteus species, and Serratia marcescens. There are also gaps in the gram-negative coverage of sparfloxacin and grepafloxacin. Sparfloxacin [10,11] has only limited potency against P. aeruginosa, S. marcescens, Citrobacter freundii, and Proteus vulgaris; and grepafloxacin [12] lacks sufficient activity against P. aeruginosa, S. marcescens, Providencia stuartii, and Acinetobacter baumanii among gram-negative bacteria.Like ciprofloxacin and ofloxacin, the newer agents have excellent potency against genital pathogens, including Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma hominis. Their clinical efficacy in the treatment of genital chlamydial infections may differ, however, as discussed below.Against respiratory pathogens, all of the newer quinolones, such as ciprofloxacin and ofloxacin, are highly potent against Haemophilus influenzae and Moraxella catarrhalis. However, these agents exhibit greater potency than ciprofloxacin and ofloxacin against Streptococcus pneumoniae, with MIC 90 values of 1-2 mg/mL for levofloxacin [13], 0.25-0.5 mg/mL for sparfloxacin [14] and grepafloxacin [15], and 0.12-0.25 mg/mL for trovafloxacin [16]. For this reason, all have been developed for treatment of respiratory tract infections, as discussed below. Other respiratory pathogens, such as Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydia pneum...

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Section: Clinical Applicationsmentioning

confidence: 99%

New Uses for New and Old Quinolones and the Challenge of Resistance

Hooper¹

2000

Clinical Infectious Diseases

151

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“…Abstracts are available regarding the agent in nosocomial pneumonia, community-acquired pneumonia requiring hospitalization, and acute bacterial exacerbation of chronic bronchitis 52-54 and two articles described its efficacy in uncomplicated gonorrhea. 55,56 No information is available for acute sinusitis, cervicitis, prostatitis, pelvic inflammatory disease, skin and skin structure infections, surgical prophylaxis, cystitis, or gonorrhea besides that supplied by the manufacturer. Of note, trovafloxacin is indicated only for uncomplicated urinary tract infections (cystitis), and no data are available for more complicated infections such as pyelonephritis.…”

Section: Clinical Efficacy Trialsmentioning

confidence: 99%

“…A multicenter, double-blind study of 625 patients (270 men, 355 women) compared single oral doses of trovafloxacin 100 mg or ofloxacin 400 mg for the treatment of uncomplicated gonococcal urethritis or cervicitis. 55 The primary end point of the study was bacteriologic and clinical response by day 2 of therapy. The two treatments produced similar clinical responses in both men and women.…”

Section: Uncomplicated Gonorrheamentioning

confidence: 99%

Trovafloxacin: An Overview

Garey

Amsden

1999

Pharmacotherapy

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Trovafloxacin, a new synthetic naphthyridine fluoroquinolone antibiotic, is a broad-spectrum agent available orally and intravenously. It was recently approved by the Food and Drug Administration for the treatment of selected pulmonary, surgical, intraabdominal, gynecologic, pelvic, skin, and urinary tract infections. Its spectrum of activity includes aerobic gram-positive and gram-negative organisms as well as anaerobic pathogens. It is rapidly absorbed after oral administration, achieves good tissue and cerebrospinal fluid penetration, and has a half-life that allows once-daily dosing. It is hepatically metabolized, and dosage adjustments are necessary for patients with severe hepatic dysfunction but not for those with mild or moderate dysfunction or renal dysfunction. The drug has a favorable safety profile, and a high tendency for transient first-dose dizziness and/or lightheadedness in young women. Similar to other quinolones, trovafloxacin should not be taken with antacids that contain aluminum or magnesium, sucralfate, or ferrous sulfate. Trovafloxacin may prove beneficial as it allows for oral or intravenous monotherapy against indicated infections that normally require multidrug, broad-spectrum antibiotic coverage.

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“…Among evaluable patients, N. gonorrhoeae was eradicated in 99% of trovafloxacin recipients and in 98% of ofloxacin recipients, showing trovafloxacin to be a promising agent for single-dose therapy of uncomplicated gonorrhea [25].…”

Section: Gonorrheamentioning

confidence: 97%

“…In a recent multicenter, double-blind trial, 355 women with uncomplicated gonococcal cervicitis were administered, under direct supervision, a single dose of either one 100 mg tablet of trovafloxacin or two 200 mg capsules of ofloxacin [25]. Among evaluable patients, N. gonorrhoeae was eradicated in 99% of trovafloxacin recipients and in 98% of ofloxacin recipients, showing trovafloxacin to be a promising agent for single-dose therapy of uncomplicated gonorrhea [25].…”

Section: Gonorrheamentioning

confidence: 99%

Lower genital tract infections and HIV in women

Sutton

2000

Curr Infect Dis Rep

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Lower genital tract infections and HIV are major causes of morbidity and mortality among women; thier impact on the US economy amounts to several billion dollars each year. Most lower genital tract infections--and their adverse sequelae, such as pelvic inflammatory disease, ectopic pregnancy, chronic pelvic pain, and increased susceptibility to HIV--are caused by sexually transmitted diseases (STDs). This article reviews recent epidemiologic information relevant to some of the STDs that more commonly affect women, and recent advances in molecular biology, diagnostics, and treatments. Effective, consistent, and proper use of barrier contraception should be encouraged, to decrease the transmission of these infections.

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Randomized Trial of Trovafloxacin and Ofloxacin for Single-Dose Therapy of Gonorrhea

Cited by 14 publications

References 11 publications

New Uses for New and Old Quinolones and the Challenge of Resistance

New Uses for New and Old Quinolones and the Challenge of Resistance

Trovafloxacin: An Overview

Lower genital tract infections and HIV in women

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