Since the recognition of
penicillinase-producing strains of N gonorrhoeae (PPNG) in 1976, these organisms have attained a worldwide distribution. The treatment of choice for
infection due to PPNG has generally been
spectinomycin administered im. In 1981, however, an
infection from California was reported to be due to a strain of PPNG that was also resistant to
spectinomycin (MIC, greater than 2,048 micrograms/ml) [1]. Throughout 1982, seven such isolates were reported worldwide [2], and in January 1983 an epidemiologically linked series of 27 cases of
infection due to
spectinomycin-resistant PPNG occurred in Korea. Because of the apparent declining utility of
spectinomycin, we studied the efficacy and safety of
aztreonam, a synthetic
monobactam antibiotic from the Squibb Institute for Medical Research (Princeton, NJ) [3], in the treatment of acute uncomplicated gonococcal
urethritis in men. Men with gonococcal
urethritis were randomly treated with either 1 g of
aztreonam or 2 g of
spectinomycin im. Of the 112 men so treated, 93 could ultimately be evaluated: 51 who received
aztreonam and 42 who received
spectinomycin. Both drugs were 100% effective in the treatment of
urethritis produced by both
penicillin-sensitive and
penicillin-resistant strains of gonococci. Furthermore, there were no reported side effects in either group and no laboratory abnormalities attributable to the
aztreonam, with the exception of one patient with a minimally elevated level of
serum glutamic oxaloacetic transaminase (serum
glutamic pyruvic transaminase and
alkaline phosphatase levels were normal).(ABSTRACT TRUNCATED AT 250 WORDS)