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SINGLE-DOSE ORAL CEFIXIME FOR UNCOMPLICATED GONORRHEA.

Penicillin and tetracycline are no longer recommended as first-line treatments for uncomplicated gonorrhea because of the increasing incidence of drug-resistant organisms. Instead, intramuscular injections of ceftriaxone are the treatment of choice. This study compares IM ceftriaxone with a new oral cephalosporin, cefixime.

The multicenter trial randomly allocated 333 patients with uncomplicated gonorrhea to receive single doses of 400 mg or 800 mg of oral cefixime or 250 mg of IM ceftriaxone. Initial and follow-up evaluations were extensive. Complete cure was achieved in 96 percent, 98 percent, and 98 percent of the three treatment groups, respectively. Mild gastrointestinal side effects occurred slightly more often in the group taking 800 mg of cefixime, while postinjection pain occurred in 7 percent of the ceftriaxone-treated patients. All three regimens were effective in eradicating pharyngeal infection. As expected, none of the regimens eradicated concurrent chlamydial infections.

The authors recommend a single 400-mg dose of cefixime as first-line therapy in patients not allergic to beta-lactam drugs. They estimate that this drug costs about 40 percent less than ceftriaxone. In addition, based on various biologic studies, they believe that cefixime should be effective against syphilis (although this has not been proved) and that cefixime-resistant organisms are unlikely to develop. This study was supported by the manufacturer of cefixime.

— ALK

Published in Journal Watch General Medicine November 8, 1991

Citation(s):

Handsfield HH et al. A comparison of single-dose cefixime with ceftriaxone as treatment for uncomplicated gonorrhea. N Engl J Med 1991 Nov 7 325 1337-1341.

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