CEFACLOR, AN ALTERNATIVE TO 3RD-GENERATION CEPHALOSPORINS FOR THE TREATMENT OF GONOCOCCAL URETHRITIS IN THE DEVELOPING-WORLD

Objective: To reassess the in vivo and in vitro efficacy of cefaclor f or the treatment of uncomplicated gonococcal infection. Design: Open c linical trial conducted in South Africa among consecutive male patient s with symptoms and signs of uncomplicated urethritis and laboratory e vidence of gonorrhoea. Methods: Patients were treated with 3 g of cefa clor plus 1 g probenecid as a single dose. Urethral specimens were cul tured for Neisseria gonorrhoeae at the initial visit and at follow up, Patients were considered cured if follow up cultures were negative. T reatment was considered to have failed in the patients infected with i dentical gonococcal strains at the initial and at the control visit. T hose with evidence of infection at the follow up visit were administer ed 400 mg of ofloxacin and doxycycline 100 mg twice daily for 7 days. Minimal inhibitory concentrations (MICs) of cefaclor were determined b y an agar dilution technique on the gonococcal isolates from the study subjects. The results were compared with those of isolates from three other African countries. Results: Of 155 patients evaluated, 151 were cured (97%). Thirty per cent of the patients complained of adverse ef fects, mainly gastrointestinal. Even though MICs for the isolates from the three other African countries were significantly higher than thos e for the isolates from the study, none was considered resistant to ce faclor in vitro. A MICs were markedly influenced by the type of test m edium used. Conclusion: The trial demonstrated the efficacy of a singl e oral dose of cefaclor with probenecid for the treatment of uncomplic ated gonococcal urethritis in South Africa, Its potential as an altern ative therapy to third generation cephalosporins deserves to be furthe r investigated.