A randomized trial that compared oral cefixime and intramuscular ceftriaxone for the treatment of gonorrhea in pregnancy

OBJECTIVE: The purpose of this study was to evaluate prospectively the Cent ers for Disease Control recommendations for the treatment of gonococcal inf ection in pregnancy. STUDY DESIGN: One hundred sixty-one women who were referred with probable e ndocervical gonorrhea underwent pretreatment endocervical, anal, and oral c ultures for Neisseria gonorrhoeae. The women were randomly assigned to rece ive ceftriaxone 125 mg intramuscularly or cefixime 400 mg orally. Treatment was open and in a 1:1 distribution. There were 95 evaluable patients. The tests of cure cultures were performed 4 to 10 days after treatment. RESULTS: Eighty-six women (91%) had endocervical infection; 39 women (41%) had anal infection, and 11 women (12%) had pharyngeal infection. Fifty of 9 5 women (53%) had concomitant endocervical chlamydial infection. The overal l efficacy was 91 of 95 subjects (95.8%; 95% Cl, 89.6%-98.8%). Ceftriaxone was effective in 41 of 43 cases (95%; 95% Cl, 84.2%-99.4%), and cefixime wa s effective in 50 of 52 cases (96%; 95% Cl, 86.8%-99.5%). No significant di fference was noted in the overall efficacy or by site of infection. Three o f the 4 women who experienced treatment failures admitted to unprotected in tercourse before their test of cure culture. CONCLUSION: Both intramuscular ceftriaxone 125 mg and oral cefixime 400 mg appear to be effective for the treatment of gonococcal infection in pregnan cy.