TUESDAY, May 7, 2019 (Pharmacist's Briefing) -- A single dose of gentamicin is an appropriate second-line therapy for gonorrhea resistant to a single dose of ceftriaxone, according to a study published online May 2 in The Lancet.
Jonathan D.C. Ross, M.D., from Birmingham University Hospitals NHS Foundation Trust in the United Kingdom, and colleagues compared treatment with gentamicin to treatment with ceftriaxone for patients with gonorrhea. Adults aged 16 to 70 years with a diagnosis of uncomplicated genital, pharyngeal, or rectal gonorrhea were eligible for participation and were randomly assigned to receive a single intramuscular dose of gentamicin (358 patients) or ceftriaxone (362 patients). Participants also received a single dose of oral azithromycin.
The researchers found that infection had cleared for 98 and 91 percent of participants in the ceftriaxone and gentamicin groups, respectively, at two weeks (adjusted risk difference, −6.4 percent). Of the participants with genital infection, 98 and 94 percent of those in the ceftriaxone and gentamicin groups, respectively, had clearance at follow-up (adjusted risk difference, −4.4 percent). For participants with pharyngeal and rectal infection, a greater proportion had clearance in the ceftriaxone group versus the gentamicin group (adjusted risk difference, −15.3 and −7.8 percent, respectively).
"Gentamicin cannot ... be recommended to replace ceftriaxone as first-line therapy for gonorrhea," the authors write. "However, gentamicin combined with 1 g azithromycin achieved a cure rate of 94 percent for genital gonorrhea and its use might be appropriate in patients who are allergic, intolerant, or harbor a ceftriaxone-resistant infection."