One or two doses of 6-(phenoxy-proprionamide)-penicillanic acid (broxil) in acute gonorrhoea.

Oral penicillin has a number of disadvantages in the treatment of gonorrhoea; absorption is uncertain and there is no guarantee that the patient will take the tablets in the prescribed amounts or at the proper times. If apparent cure results quickly there is also the danger that some of the tablets may be retained with a subsequent temptation towards self-medication with subcurative doses on a future occasion, and an encouragement of "black market" activity. On the other hand, the advantages are obvious for those persons who really dislike injections, and the speed of administration is much quicker if the oral route is used. Also severe penicillin reactions in allergic patients tend to be less severe when the antibiotic is given orally rather than by injection. Many of the objections to oral therapy are removed if the treatment can be administered in one single dose under supervision in the clinic. Failing this, if one dose is given in the clinic and the patient is then given a second to take after a few hours, this will probably be taken. In a previous paper (Willcox, 1958), the use of phenoxymethyl penicillin (penicillin V) in gonorrhoea was described. This penicillin given by mouth was said to produce higher and more prolonged serum levels dose for dose than had previously been possible with the available penicillin preparations. Using 2-3 mega units (1-25-187 g.) of penicillin V in one or two doses, there were no failures in 33 white patients, but there were 28-6 per cent. of apparent failures in 49 followed out of 52 coloured patients. Since this time there have been new developments (Lancet, 1959). Following the work in the U.S.A. of J. C. Sheehan, who first converted penicillin G to 6-aminopenicillanic acid (and who synthesised penicillin V), the English workers, Doyle and Robinson,