Rosoxacin in the treatment of uncomplicated acute gonococcal urethritis.

SR Vagaskar, RJ Fernandez, UD Wagle, ND Rajani 
 Department of Dermatology, Seth G.S. Medical College, Parel, Bombay, Maharashtra.

Correspondence Address:
S R Vagaskar
Department of Dermatology, Seth G.S. Medical College, Parel, Bombay, Maharashtra.

Full Text

::   Introduction

Gonorrhoea is a common sexually transmitted disease caused by Neisseria gonorrhoeae. The emergence of penicillinase producing strains[1],[3],[6],[7] have posed a major problem in its treatment.

Penicillin was the mainstay of therapy in gonorrhoea but the occurrence of penicillinase producing strains has greatly undermined its efficacy. This has led to the search for alternative drugs, which could be effective against the beta lactamase strains.

Rosoxacin, a quinolone derivative, is known to be effective against beta lactamase producing strains and has the advantage of being effective in a single oral dose. The aim of the present study was to determine the efficacy of rosoxacin as a single dose therapy in uncomplicated cases of acute gonococcal urethritis in males.

::   Material and method

One hundred and twelve adult male patients who presented with uncomplicated acute gonococcal urethritis were admitted to the hospital. All patients had history of exposure, dysuria and purulent urethral discharge. They had no known hypersensitivity to any drug and on examination and investigation there was no renal, hepatobiliary or neurological disease.

Acute gonococcal infection was diagnosed by examination of Gram stained smears and culture done on modified New York City Medium at 36?C in a candle jar for 48 hours. Oxidase reaction and positive glucose fermentation test with negative results for other sugars were performed to confirm the diagnosis of gonorrhoea.[2] Antibiotic sensitivity of the strains was done on the same medium using the disc diffusion method for penicillin, rosoxacin, ampicillin, tetracycline, cotrimoxazole, erythromycin, kanamycin, gentamicin, streptomycin and chloramphenicol. Penicillinase production was tested by the chromogenic cephalosporin method[10]. Urine was tested for the presence of pus and epithelial cells. Smear, culture and urine examination were repeated on the 3rd and 7th day after admission. The patients were given a single capsule (300 mg) of rosoxacin under supervision and monitored closely especially in the first 8 hours for any untoward side effects.

::   Results

A total of 112 adult males with uncomplicated acute gonococcal urethritis were included in the study. Majority of the patients belonged to the 21-30 years age group - the youngest was 18 years and oldest 42 years old. All belonged to the lower socio-economic strata and had contracted the infection from prostitutes. Eleven strains showed penicillinase production. About 91.2% of the strains were penicillin sensitive and the resistant strains showed penicillinase production. The sensitivity of rosoxacin was 99.1% with only one case (o.9%) resistant to it. Ampicillin sensitivity was only 82.14%.

All patients including the 11 strains of penicillinase producing N. Gonorrhaea (PPNG) responded to rosoxacin, except for one patient who was PPNG negative and was resistant to rosoxacin in vitro. This patient was treated with 48 lacs of procaine penicillin and was cured. Four patients had relapse on the 7th day but responded to a second capsule of rosoxacin. Five patients complained of dizziness and epigastric distress 2 hours after drug in gestion. This subsided on its own without treatment.

::   Discussion

Resistance of gonococcal strains to penicillin has caused a significant problem in the treatment of gonorrhoea. The resistance to penicillin can either be partial (mutational in a stepwise fashion) or complete (plasmid induced penicillinase production). This study was conducted to judge the efficacy of rosoxacin in the treatment of acute gonococcal urethritis (especially because of its activity against PPNG).

Almost all strains showed sensitivity to rosoxacin with only one strain (0.90%) showing resistance. Penicillin and ampicillin showed a sensitivity of 91.2% and 82.14% respectively. The other antibiotics were of even lesser efficacy. The single strain showing rosoxacin resistance was susceptible to penicillin and responded to it. All the PPNG strains isolated were susceptible to rosoxacin. The side effects of the drug were minimal and transient.

Walsh et al[9] found a 93% cure rate with rosoxacin as a single oral 800 mg dose in 105 patients with acute gonococcal urethritis. They found a 97% cure rate with penicillin in a comparative study of 300 patients. KB Lim et a1[4] found a 94% cure rate with rosoxacin in gonorrhoea as against 89.9% with kanamycin. Panikabutra et al[5] found a cure rate of 88.5% with rosoxacin in gonorrhoea as against 100% cure rate with spectinomycin. An Indian study[8] found a 92.86% cure rate in 28 gonorrhoea patients treated with a single (300 mg) dose of rosoxacin. Seventeen of the 28 patients showed resistance to the usual therapeutic doses of penicillin on antibiotic sensitivity testing.

This study showed a 99.1% cure rate with rosoxacin in uncomplicated acute gonococcal urethritis, which is much higher than all the previous studies. The only rosoxacin resistant strain found did not produce penicillinase. Since this was an inpatient study all 112 male patients with acute gonococcal urethriris were admitted to the hospital and carefully observed and investigated for a week after administering rosoxacin. An interesting feature noted was the relapse of signs and symptoms in 4 patients on the seventh day, which responded to a second capsule of 300 mg rosoxacin. This has not been reported before in previous studies.

Rosoxacin is a single dose orally administered drug, which avoids all complications of parenteral administration seen with penicillin, especially anaphylactic shock. The side effects to rosoxacin observed by us were minimal and transient. in patients sensitive to penicillin, those harbouring PPNG strains and where facilities to do a test dose for penicillin are not available, rosoxacin is the drug of first choice. However, the high cost remains the only limiting factor in recommending it as the first, line of treatment in all cases of uncomplicated acute gonococcal urethritis.

::   Acknowledgment

This study was sponsored by Winthrop Win-Medicare Private Limited.

References