Treatment of Penicillin-Resistant<i>Neisseria gonorrhoeae</i>with Oral Norfloxacin

Crider, S R; Colby, Steven; Miller, L. K.; Harrison, William O.; Kerbs, Sharon; Berg, S. W.

doi:10.1056/nejm198407193110301

Cited by 82 publications

(23 citation statements)

References 7 publications

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“…Haase et al reported a 95% cure rate with a 3-day regimen of rosoxacin (5), and Naamara et al reported 95 and 100% cure rates for a single dose and a 3-day regimen of ciprofloxacin, respectively (7). Single-day treatments with ciprofloxacin and norfloxacin were also reported to be highly effective treatment of penicillin-resistant Neisseria gonorrhoeae (3,6). Although 500 and 1,000 mg appeared equally effective in this study among Asian men, the 5% failure rate of the 500-mg single dose among African men suggests that 1,000 mg is a more reliable dosage.…”

Section: Discussioncontrasting

confidence: 39%

Evaluation of 500- and 1,000-mg doses of ciprofloxacin for the treatment of chancroid

Bodhidatta

Taylor

Chitwarakorn

et al. 1988

Antimicrob Agents Chemother

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A randomized, double-blind study was performed comparing ciprofloxacin in a 500-mg single dose with 1,000 mg (500-mg doses given 12 h apart) for the treatment of chancroid in Thailand. Haemophilus ducreyi was isolated from 87 (48%) of 180 men with a clinical diagnosis of chancroid. For men with ulcers that were culture positive for H. ducreyi, rates of cure were 100% in the 500-mg group and 98% in the 1,000-mg group. For men with ulcers that were culture negative for H. ducreyi, rates of cure were 93% in the 500-mg group and 96% in the 1,000-mg group. The MIC of ciprofloxacin for 50% of isolates among 85 isolates of H. ducreyi was 0.007 ,ug/ml (range, 0.002 to 0.03 ,ig/ml). No significant adverse effects were detected in either group. These data indicate that both of these treatment regimens are equally effective therapies for chancroid in Thailand.Chancroid, caused by Haemophilus ducreyi, is the major cause of genital ulcer disease in developing countries and is becoming an increasingly important sexually transmitted disease in the United States (9). In Thailand, chancroid infections account for nearly 20% of the venereal disease in men (11). At present the only drug that can be given orally is erythromycin, but erythromycin must be given at least for 7 days, a regimen that is associated with poor therapeutic compliance (2,4,8). Trimethoprim-sulfamethoxazole even when given in a standard 7-day regimen is frequently not an effective treatment for chancroid in Thailand (12). A single 250-mg dose of ceftriaxone is also effective, but it must be given parenterally (12). Thus, there is a need for a shortcourse or single-dose oral regimen for the treatment of chancroid. Ciprofloxacin, a new quinolone antimicrobial agent, is very effective against H. ducreyi in vitro (10), and a single oral dose is also effective for the treatment of gonorrhea. Ciprofloxacin was an efficacious and well-tolerated treatment of chancroid with a single dose (500 mg) and a 3-day regimen (500 mg twice daily) in Africa (6, 7). In the current study, we compared two regimens of ciprofloxacin, 500 mg (one tablet) and 1,000 mg (two tablets), for the treatment of chancroid in Thailand. MATERIALS AND METHODSPatients and study design. From August 1986 to January 1987, 200 men who came to the Bangrak Hospital, Venereal Disease Clinic, Bangkok, Thailand, with genital ulcers that were suspected clinically to be chancroid and were negative by dark-field examination for Treponema pallidum were enrolled in the study. All patients were otherwise healthy, between the ages of 18 and 60 years, and willing to return for follow-up evaluation. After informed consent was obtained, demographic and historical data were recorded, ulcers were measured, and tenderness, purulence, and induration were assessed. Ulcers were cultured for H. ducreyi and herpes simplex virus (HSV), and a blood specimen was obtained for a serological test for syphilis, complete blood count, creatinine and liver function tests, and total bilirubin, alkaline phosphatase, and asparate transfer...

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Section: Discussioncontrasting

confidence: 39%

Evaluation of 500- and 1,000-mg doses of ciprofloxacin for the treatment of chancroid

Bodhidatta

Taylor

Chitwarakorn

et al. 1988

Antimicrob Agents Chemother

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“…The MIC testing identified only one strain that had a ceftriaxone MIC of >0.06 ,ug/ml, and all strains had ciprofloxacin MICs of <0.03 ,ug/ml. An earlier study that used two doses of norfloxacin also had an excellent outcome (23). Regrettably, resistance to fluoroquinolones appears to emerge quickly.…”

Section: Tmp-smxmentioning

confidence: 98%

Antimicrobial susceptibility testing of Neisseria gonorrhoeae and implications for epidemiology and therapy

Fekete

1993

Clin Microbiol Rev

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Antimicrobial susceptibility testing (AST) of Neisseria gonorrhoeae has been under development since the early days of antimicrobial agents. However, it is rarely applied to clinical isolates today. The history of the various in vitro tests to determine the susceptibility of N. gonorrhoeae to antibiotics is rich with evidence that these results predict response to therapy for almost all agents tested. Further, AST is a useful and important aspect of strain characterization and disease epidemiology in conjunction with the more specific but laborious techniques of auxotyping, serotyping, and plasmid analysis. Current technology has overcome many of the objections to AST for N. gonorrhoeae with standardization of test media and the development of an accurate disk diffusion AST method that is suited to most clinical laboratories regardless of volume or level of technical expertise. Ironically, the very low level of resistance to the current primary treatment strategy in the United States, ceftriaxone or another potent cephalosporin, makes the use of AST somewhat superfluous.

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“…Ciprofloxacin, given as a single 250-mg oral dose, cured 57 cases of gonorrhea, including 7 rectal and 3 pharyngeal infections (12). Norfloxacin given orally in two 600-mg doses 4 h apart cured all of 59 cases of gonococcal urethritis, eliminating the nasopharyngeal colonization encountered in two patients (6). Very promising are the low MICs of A-56619 against C. trachomatis.…”

mentioning

confidence: 90%

In vitro activity of A-56619 (difloxacin), A-56620, and other new quinolone antimicrobial agents against genital pathogens

Liebowitz¹,

Saunders²,

Fehler³

et al. 1986

Antimicrob Agents Chemother

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The in vitro activities of two new carboxyquinolones, A-56619 (difloxacin) and A-56620, were compared with those of ciprofloxacin, norfloxacin, and ofloxacin against genital tract pathogens. All the quinolones were highly active against Neisseria gonorrhoeae. A-56619 had the lowest MICs against Chlamydia trachomatis (MIC range, 0.125 to 0.25 ,ug/ml) and Haemophilus ducreyi (MIC for 90% of isolates tested, 0.1 ,ug/ml).The newer quinolone antimicrobial agents have been shown to have excellent activity in vitro against gonococci, including ,B-lactamase-producing strains (3,11,13,16,18), and moderate activity in vitro against Chlamydia trachomatis (2,10,14).We compared the activities of A-56619 (difloxacin), A-56620, ciprofloxacin, norfloxacin, ofloxacin, and antimicrobial agents now used for the treatment of genital infections against clinical isolates of Neisseria gonorrhoeae, Haemophilus ducreyi, Gardnerella vaginalis, Ureaplasma urealyticum, and C. trachomatis.Antimicrobial reference standards and sources were as follows: A-56619, A-56620, and erythromycin, Abbott Lab of M. hominis and 2-day-old broth cultures of U. urealyticum were inoculated into 100 ,ul of twice the required final concentration of each of the antibiotic dilutions in U-well microtiter plates. Controls containing medium only, medium plus antimicrobial agent, and medium plus M. hominis or U. urealyticum were included. The microtiter plates were sealed and incubated at 37°C until the indicator in the Mycoplasma-Ureaplasma control well changed color. The MIC was defined as the lowest concentration of antimicrobial agent which prevented color change.MIC testing of C. trachomatis was performed by a modification of a previously described method (15). Inocula of a 1-ml suspension of C. trachomatis in Eagle minimum essential medium supplemented with fetal bovine serum (10% vol/vol), glutamine (1% [vol/vol] of stock solution of 30 mg/ml), and vitamins (1% vol/vol), containing approximately 1.6 x 108 inclusion-forming units per ml, were added to flat-bottomed plastic tubes containing a cover slip monolayer of cycloheximide-treated McCoy cells. After centrifugation at 3,500 x g at 35°C for 60 min, the medium was replaced with 1 ml of supplemental Eagle medium containing the antimicrobial agents tested. The tubes were incubated at 35°C for 48 h. The cover slips were removed, fixed with methanol, stained with iodine, and examined by bright-field illumination for the presence of inclusions. The MIC was defined as the lowest concentration of antimicrobial agent which prevented the appearance of any inclusion bodies.The MICs of the antimicrobial agents tested against isolates of N. gonorrhoeae, H. ducreyi, U. urealyticum, G. vaginalis, and C. trachomatis are shown in Tables 1 and 2. The quinolones, cefotaxime, and ceftazidime were highly active against gonococci, including P-lactamase-producing isolates. A-56619 and A-56620 were the most active quinolones against H. ducreyi. A-56619 was the most active quinolone against both the lymphogranuloma venereum and o...

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Treatment of Penicillin-ResistantNeisseria gonorrhoeaewith Oral Norfloxacin

Cited by 82 publications

References 7 publications

Evaluation of 500- and 1,000-mg doses of ciprofloxacin for the treatment of chancroid

Evaluation of 500- and 1,000-mg doses of ciprofloxacin for the treatment of chancroid

Antimicrobial susceptibility testing of Neisseria gonorrhoeae and implications for epidemiology and therapy

In vitro activity of A-56619 (difloxacin), A-56620, and other new quinolone antimicrobial agents against genital pathogens

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