Cefotaxime

Infection with Neisseria gonorrhoeae is common in the United States, with an annual incidence of 300 cases per 100,000 persons. Because an increasing proportion of infections are caused by N. gonorrhoeae organisms that are resistant to first-line antibiotics such as penicillin, ampicillin and tetracycline, the Centers for Disease Control and Prevention has recommended that patients with uncomplicated gonorrhea be treated with a single intramuscular injection of 250 mg of ceftriaxone, as well as a seven-day course of oral doxycycline to treat any coexisting chlamydial infection. Evidence suggests that another third-generation cephalosporin, cefotaxime, has equivalent activity against N. gonorrhoeae. The cost of cefotaxime is about 30 percent lower than that of ceftriaxone. In an open, randomized study, Mogabgab and Lutz compared the efficacy and cost of cefotaxime and ceftriaxone.

One hundred fifty-two patients with uncomplicated gonorrhea of the urethra, cervix, pharynx and/or rectum were included in the study. Children, pregnant women and patients with disseminated infection, other significant medical conditions, recent antibiotic use or hypersensitivity to cephalosporins or penicillins were excluded from the study. Eligible patients were randomly assigned to receive either 500 mg of cefotaxime or 250 mg of ceftriaxone by intramuscular injection. Repeat examination, including culture, was performed four to seven days after treatment. Patients began treatment with oral doxycycline for concomitant chlamydial infection at the follow-up visit.

Patients were predominantly black men with an average age of 23 years. The two treatment groups did not differ with respect to age, race, ratio of men to women and duration of symptoms before treatment. Also, the proportion of drug-resistant organisms was comparable between the two treatment groups. Overall, 10.1 percent of isolates were resistant to penicillin and 12.4 percent were resistant to tetracycline.

The rate of bacteriologic elimination was 99 percent in patients treated with cefotaxime and 100 percent in those treated with ceftriaxone. At follow-up, one patient had a positive culture for N. gonorrhoeae and was believed to have become reinfected. Clinical effectiveness, based on improvement or clearing of symptoms, was 78 percent for patients who received cefotaxime and 83 percent for patients who received ceftriaxone. Adverse effects were reported by 20 patients and were predominantly related to pain at the injection site. No patient suffered significant adverse effects from treatment.

The authors conclude that in the treatment of uncomplicated gonorrhea, both cefotaxime and ceftriaxone produce bacteriologic clearing and clinical response and are well tolerated by patients. The authors estimate a potential annual savings of $18,240 for the clinic at which the study was conducted by switching from ceftriaxone to cefotaxime. (Southern Medical Journal, April 1994, vol. 87, p. 461.)

COPYRIGHT 1994 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group