Intramuscular injection of procaine penicillin combined with oral administration of chloramphenicol in the treatment of gonorrhoea.

In the last few years we have witnessed an increase in the numbers of gonococcal strains which are relatively resistant to penicillin and a subsequent rise in treatment failures. It was therefore considered necessary to find a substitute for, or a modification of, the routine treatment with benzyl procaine penicillin. In a previous paper (Gjessing and Odegaard, 1965), the results of intramuscular injection of procaine penicillin combined with the oral administration of ampicillin have been described, and the pharmacological, psychological, and epidemiological reasons why it was considered advantageous to continue the injection of procaine penicillin combined with oral ampicillin are briefly discussed. The present paper deals with the injection of procaine penicillin combined with oral chloramphenicol. Since 1959 when we started the routine examination of the sensitivity of gonococci to several antibiotics, not a single strain with reduced sensitivity to chloramphenicol was observed in more than 2,000 cases. In several cases of relapse after the intramuscular injection of benzyl procaine penicillin, oral chloramphenicol was given without further failure. We have observed no complications due to this drug, although serious side-effects, especially aplastic anaemia, have been described by other workers. Shaw and McLean (1957) reported lethal cases following the administration of only 3 5 and 8 g. chloramphenicol. However, it seems that complications are usually due to large doses and/or prolonged treatment. We have not used chloramphenicol intramuscularly because this method is often accompanied by severe local pain and faintness (Willcox, 1963). As far as is known no serious harm has been observed after the oral administration of chloramphenicol in very small doses, e.g. I g., and we therefore considered it worth while to try a schedule consisting of one intramuscular injection of procaine penicillin 600,000 units combined with oral chloramphenicol in doses of 0 5 or 0 75 g.