Perfioxacin and ciprofloxacin in the treatment of uncomplicated gonococcal urethritis in males

Objective-To study the effectiveness of single-dose perfloxacin and ciprofloxacin in the treatment of uncomplicated gonococcal urethritis in males. Setting-Department of STD Control, Kelantan Road, Singapore. Method-160 male patients with uncomplicated gonococcal urethritis were assigned alternately to receive single oral doses of either perfloxacin 800 mg or ciprofloxacin 250 mg. Results-Of the perfloxacin group 98-5% (65166 patients) and of the ciprofloxacin group 98-6% (74175 patients) were cured of gonorrhoea. The rates of post-gonococcal urethritis were 64.3% and 67-3% in the perfloxacin and ciprofloxacin groups, respectively. Both drugs were well tolerated and reported side-effects were minor and transient. There was a high incidence of penicillinase-producing gonococci (32.3%) and tetracycline resistant isolates with MIC > 2 mgI (99.3%). High level tetracycline resistance (MIC > 16 mgIl) was found in 744% of isolates. Conclusion-The drugs in the dosages studied may be recommended for firstline treatment of uncomplicated gonococcal urethritis in males in Singapore. However, the emergence of bacterial resistance to the fluoroquinolones in the literature calls for vigilance in the monitoring of antimicrobial susceptibility. National Skin Centre, Singapore L L Cheong R KW Chan Singapore General Hospital M Nadarajah Address for correspondence: Dr Cheong Lai Leng, National Skin Centre, 1 Mandalay Rd, Singapore 1130. Accepted for publication 27 March 1992 Introduction The increasing incidence of penicillinase-producing Neisseria gonorrhoeae has spurred efforts the world over in search of alternatives to penicillin for treatment. The fluoroquinolones have been hailed as attractive drugs for this purpose as they can be administered orally, are highly bactericidal with minimal side-effects and possess a wide antibacterial spectrum.' Several clinical studies have documented high cure rates of gonococcal infection with the use of fluoroquinolone antibiotics.2`6 In view of such encouraging findings, we felt it important to investigate the effectiveness of two readily available fluoroquinolones, perfloxacin and ciprofloxacin, in the eradication of N. gonorrhoeae infection in the local population. Materials and method The study population comprised males, aged 18 years and above, with uncomplicated gonococcal urethritis attending the Sexually Transmitted Diseases Clinic at the Kelantan Road Polyclinic between February and November 1990. Exclusion criteria included antibiotic therapy within the past seven days, known allergy to quinolones and renal, hepatic or haematological disorders. Verbal consent for participation in the study was obtained from all