Summary
Cephalosporins have a role in the treatment of gonorrhoea, and especially infections caused by strains that are penicillin-resistant, either because they produce plasmid-mediated β-lactamase or they have chromosomally mediated diminished permeability or modified penicillin-binding proteins. Although none of the oral or Group I agents are useful, most of the Group II, III and IV agents are, and especially cefuroxime, cefotaxime, ceftriaxone and cefoxitin. In addition to uncomplicated urethral, cervical or rectal infections, appropriate regimens are also effective for the treatment of pharyngeal infections, disseminated infections and gonococcal ophthalmia.
The cephalosporins have no clear role in the treatment of syphilis, granuloma inguinale, Mycoplasma or chlamydial infections or bacterial vaginosis, but ceftriaxone may be effective in chancroid, and cefoxitin in combination with an antichlamydial agent (such as a tetracycline) might be used for the treatment of pelvic inflammatory disease.
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References
Ahonkai, V.I.; Cherubin, C.E. and Shielman, M.E.: In vitro activity of cefodizime (HR221). Antimicrobial Agents and Chemotherapy 22: 715 (1982).
Arya, O.P. and Phillips, I.: Antibiotic sensitivity of gonococci and treatment of gonorrhoea in Uganda. British Journal of Venereal Disease 46: 149 (1970).
Ashford, W.A.; Golash, R.G. and Hemming, V.G.: Penicillinase-producing Neisseria gonorrhoeae. Lancet 2: 657 (1976).
de Beer, J.A.A.; van den Ende, J. and Odendaal H.J.: Efficacy of ampicillin and cefoxitin in the treatment of acute pelvic inflammatory disease. South African Medical Journal 64: 733 (1983).
Blackwell, A.L. and Barlow, D.: Clinical diagnosis of anaerobic vaginosis (non-specific vaginitis): a practical guide. British Journal of Venereal Disease 58: 387 (1982).
Bowie, W.R.: Lack of in vitro activity of cefoxitin, cefamandole, cefuroxime and piperacillin against Chlamydia trachomatis. Antimicrobial Agents and Chemotherapy 21: 339 (1982).
Brunham, R.C.: Therapy for acute pelvic inflammatory disease: a critique of recent treatment trials. American Journal of Obstetrics and Gynecology 148: 235 (1984).
Cevenini, R.; Landini, M.P.; Donati, M. and Rumpianesi, F.: Antimicrobial drug susceptibility of 15 strains of Chlamydia trachomatis recently isolated from cases of non-gonococcal urethritis in Italy. Journal of Antimicrobial Chemotherapy 6: 294 (1980).
Communicable Disease Surveillance Centre: Sexually transmitted disease surveillance — 1984. British Medical Journal 293: 942 (1986).
Csonka, G.W. and Murray, M.: Cephaloridine in the treatment of non-gonococcal urethritis. Postgraduate Medical Journal 43 (Suppl.): 123 (1967).
de Hoop, D.; Nayyar, K.C.; Van Klingeren, B.; Stolz, E. and Michel, M.F.: Infections with non-penicillinase-producing Neisseria gonorrhoeae treated with cefuroxime: treatment failures. Sexually Transmitted Diseases 9: 200 (1982).
de Koning, G.A.J.; Tio, D.; van den Hoek, J.A.R. and van Klingeren, B.: Single 1g dose of cefotaxime in the treatment of infections due to penicillinase-producing strains of Neisseria gonorrhoeae. British Journal of Venereal Disease 59: 100 (1983).
Dougherty, T.J.; Koller, A.E. and Tomasz, A.: Penicillin-binding proteins of penicillin-susceptible and intrinsically resistant Neisseria gonorrhoeae. Antimicrobial Agents and Chemotherapy 18: 730 (1980).
Dougherty, T.J.; Koller, A.E. and Tomasz, A.: Competition of β-lactam antibiotics for the penicillin-binding proteins of Neisseria gonorrhoeae. Antimicrobial Agents and Chemotherapy 20: 109 (1981).
Dougherty, T.J.: Intrinsic resistance: penicillin target alterations and effects on cell wall synthesis; in Leive and Schlessinger (Eds) Microbiology — 1984, p. 398 (American Society for Microbiology, Washington 1984).
Droegemueller, W.: Pelvic inflammatory disease: changing management concepts. Drug Therapy (Hospital) 9: 67 (1984).
Duncan, W.C. and Knox, J.M.: Cephalexin therapy for infectious syphilis. Archives of Dermatology 110: 77 (1974).
Duncan, W.C.: Treatment of gonorrhea with cefazolin plus probenecid. Journal of Infectious Diseases 130: 398 (1974).
Duncan, W.C. and McBride, M.E.: Single-dose treatment of uncomplicated gonococcal urethritis: a comparison of cefonicid and penicillin. Sexually Transmitted Diseases 9: 93 (1982).
Fast, M.W.; Nsanze, H.; D’Costa, L.J.; Karasira, P.; Maclean, I.W.; Piot, P.; Albritton, W.L. and Ronald, A.R.: Antimicrobial therapy of chancroid: an evaluation of five treatment regimens correlated with in vitro sensitivity. Sexually Transmitted Diseases 10: 1 (1983).
Flarer, F.: On the antitreponemic action of cephaloridine. Postgraduate Medical Journal 43 (Suppl.): 133 (1967).
Gibbs, R.S.: Moxalactam therapy of pelvic inflammatory disease and pelvic infection; in Periti and Grassi (Eds) Current Chemotherapy and Immunotherapy: Proceedings of the 12th International Congress of Chemotherapy, Florence, July 1981, p. 555. (American Society for Microbiology, Washington DC 1982).
Gonzalez-Ochoa, A. and Moreno, J.B.: The treatment of early syphilis with cephaloridine. Postgraduate Medical Journal 43 (Suppl.): 134 (1967).
Goodhart, G.L.: Treatment of uncomplicated genital gonorrhea. Sexually Transmitted Diseases 6: 126 (1979).
Gordts, B.; Vanhoof, R.; Hubrechts, J.M.; Bierickx, R.; Coignau, H. and Butzler, J.P.: In vitro activity of 21 antimicrobial agents against Neisseria gonorrhoeae in Brussels. British Journal of Venereal Disease 58: 23 (1982).
Greaves, W.L.; Krans, S.J.; McCormack, W.M.; Biddle, J.W.; Zaidi, A.; Fiumara, N.J. and Guinan, M.E.: Cefoxitin vs penicillin in the treatment of uncomplicated gonorrhea. Sexually Transmitted Diseases 10: 53 (1983).
Guyman, L.F.; Walstad, D.L. and Sparling, F.P.: Cell envelope alterations in antibiotic-sensitive and resistant strains of Neisseria gonorrhoeae. Journal of Bacteriology 136: 391 (1978).
Hall, W.H.; Schierl, E.A. and Maccani, J.E.: Comparative susceptibility of penicillinase-positive and -negative Neisseria gonorrhoeae to 30 antibiotics. Antimicrobial Agents and Chemotherapy 15: 562 (1979).
Hamilton-Miller, J.M.T.: Microbiological investigation of cephalosporins. Drugs 34(Suppl. 2): 23 (1987).
Hammerschlag, M.R. and Gleyzer, A.: In vitro activity of a group of broad-spectrum cephalosporins and other β-lactam antibiotics against Chlamydia trachomatis. Antimicrobial Agents and Chemotherapy 23: 493 (1983).
Handsfield, H.H.: Treatment of uncomplicated gonorrhea in men with single-dose moxalactam. Sexually Transmitted Diseases 10: 191 (1983).
Handsfield, H.H. and Holmes, K.K.: Treatment of uncomplicated gonorrhea with cefotaxime. Sexually Transmitted Diseases 8: 187 (1981).
Handsfield, H.H.; Knapp, J.S.; Diehr, P.K. and Holmes, K.K.: Correlation of auxotype and penicillin susceptibility of Neisseria gonorrhoeae with sexual preference and clinical manifestations of gonorrhea. Sexually Transmitted Diseases 7: 1 (1980).
Handsfield, H.H.; Murphy, V.L. and Holmes, K.K.: Dose-ranging study of ceftriaxone for uncomplicated gonorrhea in men. Antimicrobial Agents and Chemotherapy 20: 839 (1981).
Harrison, W.O.; Sanchez, P.L.; Lancaster, D.J.; Kerbs, S.B.J. and Berg, S.W.: Ceftizoxime (FK-749) is effective therapy for urethritis caused by penicillinase-producing Neisseria gonorrhoeae. Sexually Transmitted Diseases 11: 30 (1984).
Hatley, L.H. and Droegemueller, W.: Pelvic inflammatory disease; in Current Therapy, p.871 (W.B. Saunders, Philadelphia 1983).
Ison, C.A.; Littlewood, K.; Shannon, K.P.; Easmon, C.S.F. and Phillips, I.: Spectinomycin-resistant gonococci. British Medical Journal 287: 1827 (1984).
Jones, R.N.; Barry, A.L.; Thomsberry, C.; Gerlach, E.H.; Fuchs, P.C.; Gavan, T.L. and Sommers, H.M.: Ceftazidime, a pseudomonas-active cephalosporin: in vitro antimicrobial activity evaluation including recommendations for disc diffusion susceptibility tests. Journal of Antimicrobial Chemotherapy 8(Suppl. B): 187 (1981).
Judson, F.N.; Ehret, J.M. and Root, C.J.: Comparative study of ceftriaxone and aqueous procaine penicillin G in the treatment of uncomplicated gonorrhea in women. Antimicrobial Agents and Chemotherapy 23: 218 (1983).
Kamey, W.W.; Turck, M. and Holmes, K.K.: Cefazolin in the treatment of gonorrhea. Journal of Infectious Diseases 128 (Suppl.): 399 (1973).
Kim, J.H.; Ro, Y.S. and Kim, Y.T.: Cefoperazone (Cefobid) for treating men with gonorrhoea caused by penicillinase-producing Neisseria gonorrhoeae. British Journal of Venereal Disease 60: 238 (1984).
King, A.; Nicol, C. and Rodin, P.: Venereal Diseases, 4th ed., p. 268 (Balliere Tindall and Cassall, London 1980a).
King, A.; Warren, C.; Shannon, K. and Phillips, I.: The in vitro antibacterial activity of cefotaxime compared with that of cefuroxime and cefoxitin. Journal of Antimicrobial Chemotherapy 6: 479 (1980b).
Leitner, F.; McGregor, M.C. and Pursiano, T.A.: Comparative antibacterial spectrum of cefadroxil. Journal of Antimicrobial Chemotherapy 10(Suppl. B): 1 (1982).
Lindberg, M.; Ringertz, O. and Sandström, E.: Treatment of pharyngeal gonorrhoea due to β-lactamase-producing gonococci. British Journal of Venereal Disease 58: 101 (1982).
Livermore, D.M.: Mechanisms of resistance to cephalosporin antibiotics. Drugs 34(Suppl. 2): 64 (1987).
Lossik, J.G.; Thompson, S.E. and Smeltzer, M.P.: Comparison of cefuroxime and penicillin in the treatment of uncomplicated gonorrhoea. Antimicrobial Agents and Chemotherapy 22: 409 (1982).
Lucas, J.B.; Thayer, J.D.; Utley, P.M.; Billings, T.E. and Hackney, J.F.: Cephalothin therapy in male gonorrhea. Antimicrobial Agents and Chemotherapy 5: 686 (1965).
Lutz, B.; Mogabgab, W.J.; Parks, D.; Pauling, B and Beville, R.: Comparison of ceftizoxime and penicillin for the treatment of uncomplicated gonorrhoea. Journal of Antimicrobial Chemotherapy 10(Suppl. C): 229 (1982).
Marshall, M.J. and Curtis, F.R.: Single doses of cephaloridine in the treatment of gonococcal urethritis in males. Postgraduate Medical Journal 43 (Suppl.): 121 (1967).
Martin, S.E.: In vitro susceptibility of Neisseria gonorrhoeae to nine antimicrobial agents. Applied Microbiology 18: 21 (1969).
MMWR: Centers for Disease Control, Morbidity and Mortality Weekly Report 34 (No. 4S): 33S–60S (1985).
Moberg, I. and Wennberg, K.: Treatment of females with acute gonorrhoea using cefuroxime. Proceedings of the Royal Society of Medicine 70(Suppl. 9): 128 (1977).
Monson, T.P.; Miller, T.T. and Nolan, C.M.: Cefotaxime treatment of pelvic inflammatory disease. Antimicrobial Agents and Chemotherapy 20: 847 (1981).
Muytjens, H.L. and Heessen, F.W.A.: In vitro activities of thirteen β-lactam antibiotics against Chlamydia trachomatis. Antimicrobial Agents and Chemotherapy 22: 520 (1982).
Ng, W.S.; Chau, P.Y. and Arnold, K.: In vitro susceptibility of Haemophilus influenzae and Neisseria gonorrhoeae to Ro 13-9904 in comparison with other β-lactam antibiotics. Antimicrobial Agents and Chemotherapy 19: 925 (1981).
Ng, W.W.S.; Echeverria, P.; Rockhill, R. and Duangmani, C.: Antibiotic sensitivities of Neisseria gonorrhoeae in the Far East: comparison of plasmid species in isolates for six countries. Sexually Transmitted Diseases 9: 120 (1982).
Nicholis, J. and Loucopoulos, A.: Cephalothin in the treatment of syphilis. British Journal of Venereal Disease 50: 270 (1974).
Noble, R.C. and Parekh, M.C.: Association of auxotypes of Neisseria gonorrhoeae and susceptibility to penicillin G, spectinomycin, tetracycline, cefaclor, cefoxitin and moxalactam. Sexually Transmitted Diseases 10: 18 (1983).
Norrby, S.R.: Side effects of cephalosporins. Drugs 34(Suppl. 2): 105 (1987).
Obaid, S.R.; Kahn, M.Y.; Simpson, M.L.; Gruninger, R.P. and Wigren, D.I.: Comparative efficacy of cefmenoxime versus penicillin in the treatment of gonorrhea. Antimicrobial Agents and Chemotherapy 23: 349 (1983).
Oiler, L.Z.: Further experience with cephaloridine in gonorrhoea. Postgraduate Medical Journal 43 (Suppl.): 124 (1967a).
Oiler, L.Z.: Cephaloridine in early syphilis. Postgraduate Medical Journal 43 (Suppl.): 124 (1967b).
Oiler, L.Z.; Smith, H.G. and Marshall, M.J.: Cephaloridine and cephalexin in venereological practice. Postgraduate Medical Journal 46 (Suppl.): 99 (1970).
Palomares, J.C.; Dardet, C.A. and Perea, E.J.: A new previously undescribed plasmid in penicillinase-producing Neisseria gonorrhoeae in Spain. Journal of Antimicrobial Chemotherapy 13: 397 (1984).
Panconesi, E.; Zuccati, G. and Cantini, A.: Treatment of syphilis: a short critical review. Sexually Transmitted Diseases 8: 321 (1981).
Panikabutra, K.; Ariyarit, C.; Chitwarakom, A. and Salnsanoh, C.: Cefaclor and cefamandole as alternatives to spectinomycin in the treatment of men with uncomplicated gonorrhoea. British Journal of Venereal Disease 59: 298 (1983).
Percival, A.; Rowlands, J.; Corkill, J.E.; Alergant, C.D.; Arya, O.P.; Rees, E. and Annels, E.H.: Penicillinase-producing gonococci in Liverpool. Lancet 2: 1379 (1976).
Pheifer, T.A.; Forsyth, P.S.; Durfee, M.A.; Pollack, H.M. and Holmes, K.K.: Non-specific vaginitis. Role of Haemophilus vaginalis and treatment with metronidazole. New England Journal of Medicine 298: 1429 (1978).
Phillips, I.: β-lactamase-producing, penicillin resistant gonococcus. Lancet 2: 656 (1976).
Phillips, I.: The susceptibility of Neisseria gonorrhoeae to cefoxitin sodium. Journal of Antimicrobial Chemotherapy 4(Suppl. B): 61 (1978).
Phillips, I.; King, A.; Warren, C.; Watts, B. and Stoate, M.W.: The activity of penicillin and eight cephalosporins on Neisseria gonorrhoeae. Journal of Antimicrobial Chemotherapy 2: 31 (1976).
Phillips, I. and Shannon, K.: The activity of cephalosporins on β-lactamase-producing Neisseria gonorrhoeae. Scandinavian Journal of Infectious Diseases 13 (Suppl.): 23 (1978).
Piot, P.; van Dyck, E. and Meheus, A.: Activity in vitro of cefuroxime and six other antimicrobial agents against Neisseria gonorrhoeae isolated in Belgium and Rwanda. Proceedings of the Royal Society of Medicine 70(Suppl. 9): 118 (1977).
Price, J.D. and Fluker, J.L.: Dose response evaluation of cefuroxime in the treatment of gonorrhoea in male and female patients. Proceedings of the Royal Society of Medicine 70(Suppl. 9): 125 (1977).
Rajan, V.S.; Sng, E.H.; Thirumoorthy, T. and Goh, C.L.: Ceftriaxone in the treatment of ordinary and penicillinase-producing strains of Neisseria gonorrhoeae. British Journal of Venereal Disease 58: 314 (1982).
Rein, M.F.: Biopharmacology of syphilotherapy. Journal of the American Venereal Disease Association 3: 109 (1976).
Reyn, A.; Komer, B. and Bentzon, M.W.: Effects of penicillin, streptomycin and tetracycline on N. tigonorrhoeae isolated in 1944 and 1957. British Journal of Venereal Disease 34: 227 (1958).
Ridgway, G.L. and Oriel, J.D.: Activity of antimicrobials against Chlamydia trachomatis in vitro. Journal of Antimicrobial Chemotherapy 5: 483 (1979).
Ridgway, G.L.; Owen, J.M. and Oriel, J.D.: A method for testing the antibiotic susceptibility of Chlamydia trachomatis in a cell culture system. Journal of Antimicrobial Chemotherapy 2: 71 (1976).
Ridgway, G.L.; Owen, J.M. and Oriel, J.D.: The antimicrobial susceptibility of Chlamydia trachomatis in cell culture. British Journal of Venereal Disease 54: 103 (1978).
Roberts, M.C.; Hillier, S.L.; Schoenknecht, F.D. and Holmes, K.K.: Comparison of Gram stain, DNA probe, and culture for the identification of species of Mobiluncus in female genital specimens. Journal of Infectious Diseases 152: 74 (1985).
Rodriguez, J.; Fuxeuch-Chiesa, Z.; Ramirez-Ronda, C.H.; Kouri, Y.; Cuevas, R.; Nevarez, M. and Perez, M.: In vitro susceptibility of 50 non-β-lactamase-producing Neisseria gonorrhoeae strains to 20 antimicrobial agents. Antimicrobial Agents and Chemotherapy 23: 242 (1983).
Sanchez, P.L.; Wignall, F.S.; Zajdowicz, T.R.; Kerbs, S.; Berg, S.W. and Harrison, W.O.: One gram of cefoxitin cures uncomplicated gonococcal urethritis caused by penicillinase-producing Neisseria gonorrhoeae (PPNG). Sexually Transmitted Diseases 10: 135 (1983).
Seftel, H.C.: Clinical experience with cephaloridine in South Africa. Postgraduate Medical Journal 43 (Suppl.): 137 (1967).
Seth, A.D.; Kolator, B. and Wilkinson, A.E.: Sensitivity of Neisseria gonorrhoeae to antibiotics in London (1976–1978). British Journal of Venereal Disease 55: 325 (1979).
Siegal, M.S.; Thompson, S.E.; Perine, P.L.; Brown, S.T.; Reynolds, G. and Thornsberry, C.: Treatment of uncomplicated gonococcal urethritis with cefoxitin: comparison with penicillin. Reviews of Infectious Diseases 1: 183 (1979).
Simpson, M.L.; Khan, M.Y.; Siddiqui, Y.; Gruninger, R.P. and Wigren, D.I.: Treatment of gonorrhoea: comparison of cefotaxime and penicillin. Antimicrobial Agents and Chemotherapy 19: 798 (1981).
Slutkin, G.; Gottlieb, A. and Mills, J.: Ceftizoxime for treatment of gonorrhoea. Journal of Antimicrobial Chemotherapy 10(Suppl. C): 237 (1982).
Sparling, P.F.: Antibiotic resistance in the gonococcus; in Roberts (Ed.) The Gonococcus, p. 112 (Wiley, New York 1977).
Sparling, P.F. and Lee, T.J.: Gonorrhoea: new insights and problems; in Weinstein and Fields (Eds) Seminars in Infectious Disease I, p.34 (Stratton, New York 1978).
Spencer, R.C.; Smith, T. and Talbot, M.D.: Ceftizoxime in the treatment of uncomplicated gonorrhoea. British Journal of Venereal Disease 60: 90 (1984).
Spiegel, C.A.; Amsel, R.; Eschenbach, D.; Schoenknecht, F. and Holmes, K.K.: Anaerobic bacteria in non-specific vaginitis. New England Journal of Medicine 303: 601 (1980).
Sweet, R.; Schacter, J. and Robbie, M.: Acute salpingitis: role of chlamydia in the United States; in Mardh, Holmes, Oriel et al. (Eds) Chlamydial Infections, p. 175 (Elsevier Biomedical Press, Amsterdam 1982).
Taylor, E.; Blackwell, A.L.; Barlow, D. and Phillips, I.: Gardnerella vaginalis, anaerobes and vaginal discharge. Lancet 1: 1376 (1982).
Thin, R.N.; Barlow, D.; Eykyn, S. and Phillips, I.: Imported penicillinase producing Neisseria gonorrhoeae becomes endemic in London. British Journal of Venereal Disease 59: 364 (1983).
Thompson, S.E.: Treatment of syphilis in pregnancy. Journal of the American Venereal Disease Association 3: 159 (1976).
Thomsberry, C.; Biddle, J.W.; Perine, P.L. and Siegel, M.: In vitro susceptibility of β-lactamase positive and β-lactamase negative strains of Neisseria gonorrhoeae to cefuroxime. Proceedings of the Royal Society of Medicine 70(Suppl. 9): 122 (1977).
Tupasi, T.E.; Calubiran, O.V. and Torres, C.A.: Single oral dose of cefaclor for the treatment of infections with penicillinase-producing strains of Neisseria gonorrhoeae. British Journal of Venereal Disease 58: 176 (1982).
Walter, A.M. and Heilmeyer, L.: Antibiotika-Fibel, p. 947 (Verlag, Stuttgart 1975).
Warner, P.F.; Zubrzycki, L.J. and Chila, M.: Polygenes and modifier genes for tetracycline and penicillin resistance in Neisseria gonorrhoeae. Journal of General Microbiology 117: 103 (1980).
Warren, C.: An epidemiological study of β-lactamase-producing gonococci isolated at St Thomas’ Hospital, 1976–1982. MSc Thesis, University of Surrey (1983).
Willcox and Woodcock: Cephalexin in the oral treatment of gonorrhoea by a double-dose method. Postgraduate Medical Journal 46 (Suppl.): 103 (1970).
Xerri, L. and Orsolini, P.: In vitro activity of cefuroxime against Treponema pallidum. Journal of Antimicrobial Chemotherapy 4: 189 (1978).
Zajdowicz, T.R.; Kerbs, S.B.; Berg, W. and Harrison, W.O.: Laboratory-acquired gonococcal conjunctivitis: successful treatment with single-dose ceftriaxone. Sexually Transmitted Diseases 11: 28 (1984).
Zajdowicz, T.R.; Sanchez, P.L.; Berg, S.W.; Kerbs, S.B.J.; Newquist, R.L. and Harrison, W.O.: Comparison of ceftriaxone with cefoxitin in the treatment of penicillin-resistant gonococcal urethritis. British Journal of Venereal Disease 59: 176 (1983).
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Phillips, I. Role of Cephalosporins in Gonorrhoea and Other Sexually Transmitted Diseases. Drugs 34 (Suppl 2), 164–179 (1987). https://doi.org/10.2165/00003495-198700342-00013
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DOI: https://doi.org/10.2165/00003495-198700342-00013