The aim of this study was to compare the efficacy of single-dose
pefloxacin 400 mg and
ciprofloxacin 250 mg in the treatment of acute uncomplicated gonococcal
urethritis in males. One hundred and twenty male patients with uncomplicated gonococcal
urethritis were assigned alternately to receive single oral doses of either
pefloxacin 400 mg or
ciprofloxacin 250 mg. Forty-one out of 43 patients (95.3%) of the
pefloxacin group and 46 of 47 (97.9%) of the
ciprofloxacin group were cured of gonorrhoeae. The rates of post-gonococcal
urethritis were 57.7% and 53.3% in the
pefloxacin and
ciprofloxacin groups respectively. There was a high incidence of
penicillinase-producing gonococci (34.2%). High level resistance to
pefloxacin (minimum inhibitory concentration [MIC] >1.0 mg/l) resulting in clinical failure on 400 mg stat dose was noted in 1 isolate. It also showed decreased susceptibility to
ciprofloxacin (MIC 0.25 mg/l). Another isolate showed high-level resistance (MIC 0.06 mg/l) to
ciprofloxacin 250 mg stat dose with concomitant decreased susceptibility to
pefloxacin (MIC >1.0 mg/l).
Ciprofloxacin 250 mg stat dose is still useful for the treatment of uncomplicated gonococcal
urethritis in males. The cure rate of 95.3% with
pefloxacin at 400 mg stat dose is acceptable, but needs to be monitored with caution. The emergence of a more resistant strain of Neisseria gonorrhoeae to
fluoroquinolones calls for vigilance in the monitoring of antimicrobial susceptibility.