The progressive increase in the resistance of N. gonorrhoeae to antibiotics, particularly the alarming discovery of beta-lactamase producing strains, has created an urgent need to reevaluate the treatment of gonococcal infection and to search for effective alternative treatment regimens.
Thiamphenicol, a chloramphenicol analog in which the nitro group has been substituted with a methylsulfonyl group, has been suggested as an alternate drug to penicillins.
The initial study population, 225 male uncomplicated gonorrhea patients, were treated with two regimens in the period October, 1982 to February, 1983. They were divided into two groups and assigned to treatment with 2.5 gm thiamphenicol PO (regimen A) or 2.0 gm spectinomycin IM (regimen B) according to a random number sheet.
Out of 225 patients 196 patients returned 3-5 days after the treatment for a test of cure. Sixty three (41.4%) of 152 patients who received thiamphenicol failed to recover, 25 (56.8%) of 44 PPNG urethritis and 38 (35.2%) of 108 non-PPNG urethritis. Forty eight-of these failure cases except one and those 44 in the regimen B who received spectinomycin recovered.
The unacceptably high failure rate found in our trial in the treatment of both PPNG and non-PPNG urethritis with thiamphenicol 2.5 gm PO regimen is quite disappointing. The high MIC to thiamphenicol found in isolates from Seoul, Korea is undoubtedly the cause of the high failure rate.
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