Biomedical subjects
Publications and source records attributed to A Chitwarakorn.
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Each of 200 men with uncomplicated gonococcal urethritis was randomly assigned to a group receiving one of two therapeutic regimens. Group A received 2 g of spectinomycin intramuscularly. Group B received 2.5 g of thiamphenicol, with 500 mg administered intramuscularly just after oral administration of 2 g. Of the 89 patients in group A who completed the study, 32 were infected with penicillinase-producing Neisseria gonorrhoeae, 49 with non-penicillinase-producing N. gonorrhoeae, and eight with gonococcal strains not tested for penicillinase production. Infection was cured in all 89 patients. Of the 91 patients in group B who completed the study, 33 were infected with penicillinase-producing N. gonorrhoeae, 54 with non-penicillinase-producing N. gonorrhoeae, and four with gonococcal strains not tested for penicillinase production. Infection was cured in 86 (94.5%) of the 91 patients. Thus, the single-dose regimen of thiamphenicol was effective against uncomplicated infections caused by either penicillinase-producing or non-penicillinase-producing strains of N. gonorrhoeae.
The etiology of urethritis was determined for 303 Thai men with urethral discharge containing 5 or more polymorphonuclear cells (PMN)/high power field (hpf) and 132 men with a discharge containing less than 5 PMN/hpf. Neisseria gonorrhoeae was isolated significantly more often from men with greater than or equal to 5 PMN/hpf than from men with less than 5 PMN/hpf (42% vs 1%, P less than .0001). Chlamydia trachomatis was also isolated more often from patients with greater than or equal to 5 PMN/hpf than from men with less than 5 PMN/hpf (16% vs 8%, P less than .03). Ureaplasma urealyticum was isolated with nearly equal frequency from both groups of patients (45% vs 37%). Among men with a urethral exudate containing greater than or equal to 5 PMN/hpf, N. gonorrhoeae was isolated as the only pathogen from 19% and in combination with C. trachomatis or U. urealyticum in 23% of these men. C. trachomatis or U. urealyticum, but not N. gonorrhoeae, was isolated from 30%, and no pathogen was isolated from 28% of these men. Among men with urethral exudate containing less than 5 PMN/hpf, N. gonorrhoeae was isolated from only 1%, C. trachomatis or U. urealyticum from 41%, and no pathogen from 58%. These findings suggest that all Thai men with urethral discharge containing greater than or equal to 5 PMN/hpf should be treated for non-gonococcal urethritis and for gonococcal urethritis if gram-negative diplococci are demonstrated on gram stain of the urethral discharge. Men with urethritis with less than 5 PMN/hpf should be treated for only non-gonococcal urethritis.
In this randomized dose range study conducted in Bangkok, 326 patients with presumed acute uncomplicated gonorrhoea were treated with a single intramuscular dose of either 0.25 g, 0.5 g, or 1.0 g of a new aminothiazole cephalosporin, cefodizime. One hundred and eighty men and 110 women were evaluable for efficacy. Pathogens were eliminated in all but 4 of these patients resulting in a cure rate of 99%, irrespective of dose, sex, or multiplicity of infected sites. A high percentage of the 290 strains of Neisseria gonorrhoeae isolated from the evaluable patients showed resistance to penicillin, and 40% were penicillinase producing (PPNG). The minimum inhibitory concentration of cefodizime for 90% of the PPNG strains was less than 0.04 mg/l. No clinically relevant adverse drug reactions were reported. This study demonstrates that a single 0.25 g dose of cefodizime is effective against both PPNG and non-PPNG strains in a geographic region characterized by high endemic antibiotic resistance.