MULTICENTER TRIAL OF SINGLE-DOSE AZITHROMYCIN VS CEFTRIAXONE IN THE TREATMENT OF UNCOMPLICATED GONORRHEA

Background and Objectives: Azithromycin is a new, long-acting azalide antibiotic that is active against Neisseria gonorrhoeae. A single oral dose of 1.0 g is effective against uncomplicated genital infection wi th Chlamydia trachomatis. Goal of this Study: To compare the efficacy and tolerance of single-dose treatment of uncomplicated gonorrhea with azithromycin, 2.0 g orally, and ceftriaxone, 250 mg intramuscularly. Study Design: Seven hundred twenty-four men and women with presumptive , uncomplicated gonorrhea were treated with azithromycin 2.0 g orally or ceftriaxone 250 mg intramuscularly in a 2:1 ratio in a multicenter, open, randomized control trial in 10 public sexually transmitted dise ase clinics in the United States. Patients were followed up in 5 to 9 days and, for a subset of patients, 12 to 18 days after treatment. The main outcome measures were the isolation of N. gonorrhoeae and C. tra chomatis and patient-reported side effects. Results: Among infected pa tients who returned for follow-up, N. gonorrhoeae was eradicated from all anatomic sites in 370 of 374 (98.9%; 95% confidence interval 95%C I 97.9%-100%) treated with azithromycin and 171 of 175 (97.7%; 95%CI 95.5%-99.9%) given ceftriaxone. Treatment with either drug was effecti ve in all 73 patients infected with P-lactamase-producing N. gonorrhoe ae. Chlamydial infection was eradicated in all 17 patients given azith romycin who returned and were recultured at follow-up and in two of se ven patients given ceftriaxone (P < 0.001). Gastrointestinal side effe cts occurred in 35.3% (95%CI 30.7%-39.8%) of patients given azithromyc in; of those with symptoms, these were moderate in 10.1% and severe in 2.9%. Conclusions: Azithromycin 2.0 g and ceftriaxone 250 mg are equa lly effective in the treatment of uncomplicated gonorrhea. Azithromyci n was associated with a relatively high frequency of gastrointestinal side effects and is expensive, but it has the advantages of oral admin istration and efficacy against concomitant chlamydial infection.