Cefixime

Due to the increasing proportion of Neisseria gonorrhoeae isolates that are resistant to penicillin or tetracycline, the U.S. Public Health Service now recommends intramuscular administration of ceftriaxone (250 mg) as the single-dose regimen of choice for all uncomplicated cases of gonorrhea. Recent evidence suggests that cefixime, a new oral cephalosporin with excellent activity against N. gonorrhoeae, may also be an effective single-dose treatment. In a randomized, unblinded study, Handsfield and colleagues compared the effectiveness of cefixime with that of ceftriaxone in the treatment of uncomplicated gonorrhea.

A total of 209 men and 124 women were assigned to treatment with either cefixime in a dose of 400 mg or 800 mg orally or ceftriaxone in a dose of 250 mg intramuscularly.

Overall cure rates were 96 percent for the 400-mg dose of cefixime, 98 percent for the 800-mg dose of cefixime and 98 percent for ceftriaxone. Cefixime was effective against pharyngeal infection, as well as genital and rectal infection. None of the three regimens reliably eradicated isolates of Chlamydia trachomatis. Cefixime was well tolerated, with gastrointestinal effects such as mild diarrhea and flatulence most commonly reported.

The average wholesale cost of a 400-mg dose of cefixime is $4.69, compared with $7.46 for a 250-mg dose of ceftriaxone. The authors believe that single-dose cefixime may be a better choice for initial treatment of uncomplicated gonorrhea. They prefer the 400-mg dose because it costs less and has better gastrointestinal tolerance than the 800-mg dose. However, further studies are needed to determine the most effective dose. Regardless of the dose used, cefixime treatment should be followed by a regimen effective against C. trachomatis. (New England Journal of Medicine, November 7, 1991, vol. 325, p. 1337.)

COPYRIGHT 1992 American Academy of Family Physicians
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