From: The effectiveness of gentamicin in the treatment of Neisseria gonorrhoeae: a systematic review
Author | Methods | Participants | Intervention | Primary outcome | Evaluation of re-infection | |
---|---|---|---|---|---|---|
Gentamicin | Comparator | |||||
Hira et al. (1984) [36] | Quasi-random (treatment assigned to alternate consecutive patients) | Men with uncomplicated gonorrhoea infection (gram-negative diplococci on urethral smear), Lusaka, Zambia | Single-dose gentamicin 280 mg intramuscular injection (n = 302) | Single-dose kanamycin 2 g intramuscular injection (n = 113) | Cure | All patients advised to abstain from sexual activity for 2 weeks after therapy. |
Patients in whom N. gonorrhoea persisted or re-appeared (as determined by a positive result of a smear or culture) in the absence of sexual activity during the follow-up period were considered to be treatment failure | Patients excluded if reported sexual activity during 2Â weeks follow-up period with or without persistent or re-appearing gonorrhoea on culture | |||||
Iskandar et al. (1978) [33] | RCT (randomly allocated to 3 groups of 30 patients) | Men with acute gonorrhoea infection (gonorrhoea on Gram stain of urethral smears), Egypt | Single-dose gentamicin 240 mg intramuscular injection (n = 30) | Co-trimoxazole (Bactrim, Roche) 8 tablets daily divided into 2 doses for 2 days (n = 30). Trimethoprim-sulphametrol (Lidaprim, Ciba) 8 tablets divided into 2 doses for 2 days (n = 30) | Cure | One case of re-infection reported in which there was a history of re-exposure. |
Cases with negative smears plus resolution of discharge on day 7 were considered cured | Safe sex advice and assessment of re-infection not described | |||||
Pareek and Chowdhury (1981) [35] | Non-randomised, comparator study | Men with urethral gonorrhoea infection (culture positive and beta lactamase detected), Riyadh, Saudi Arabia | Single-dose gentamicin 160 mg intramuscular injection (n = 20) | Single-dose spectinomycin 2 g intramuscular injection (n = 20) | Cure | Safe sex advice, definition and assessment of re-infection not described |
Patients in whom culture on days 3, 7 and 14 post treatment were negative were considered cured | ||||||
Yoon et al. (1988) [34] | RCT (random numbered tickets used to divide patients into 2 groups) | Men with uncomplicated gonococcal urethritis (Gram stain and ‘bacteriological test of urethral secretions’), Seoul, Korea | Single-dose gentamicin 240 mg intramuscular injection (n = 137) | Single-dose kanamycin 2 g intramuscular injection (n = 137) | Cure | All patients advised to avoid sexual intercourse during the period of treatment. Definition and assessment of re-infection not described |
Cases with negative Gram stain and bacteriological test (undefined) of urethral secretions | ||||||
Lule et al. (1994) [28] | RCT (computerised randomisation) | Men presenting with urethral discharge +/-dysuria and gram-negative intracellular diplococci on urethral smear and/or positive culture, Malawi | Single-dose gentamicin 240 mg intramuscular injection (n = 40) | Amoxicillin 3 gm, probenecid 1 gm, and clavulanate 125 mg by mouth once (n = 60) | To determine the relative contribution of gonorrhoea and chlamydia to urethritis in Malawi | Safe sex advice not described |
Amoxicillin 3 gm, probenecid 1 gm, and clavulanate 125 mg, by mouth once and doxycycline 100 mg BD for 7 days (n = 56) | To evaluate the effectiveness of five antibiotic therapies for urethritis | 6/48 (12.5%) patients with persistent gonococcal infection at follow-up reported having sex between initial and follow-up visits compared to 21 of 249 (8.4%) men for whom gonococcal infection was not detected at follow-up (p = 0.4) | ||||
Ciprofloxacin 250 mg by mouth once (n = 59) | Cure not defined. An assessment of symptoms and signs, urethral Gram stain and culture were obtained at 8–10 days post treatment | |||||
Co-trimoxazole (trimethoprim 320 mg/sulphamethoxazole 1,600 mg) by mouth for 2 days (n = 29) |