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Two new antibiotics have been shown to be effective in treating gonorrhea.

The main antibacterial drugs recommended for the treatment of gonorrhea are currently cephalosporins, however, there is an urgent need for other treatment options in patients with allergic reactions to β-lactams in general and cephalosporins in particular; as well as infection caused by strains of cephalosporin-resistant gonococci.

A phase IV study conducted in the United States by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) evaluated the efficacy and tolerability of two new combinations of existing antibacterial drugs. in the treatment of uncomplicated urogenital gonococcal infection.

This study was the first to evaluate combination therapy for gonorrhea and its results were presented in July 2023 at the 20th meeting of the International Research Society for Sexually Transmitted Diseases (ISSTDR) in Vienna (Austria).

To achieve this goal, a randomized study was performed in patients with urogenital gonorrhea. Patients received one of 2 modes: gentamicin 240 mg i / m + azithromycin 2 g orally once (GENT / AZI mode) or gemifloxacin 320 mg orally + azithromycin 2 g orally (GEMI / mode AZI).

The main outcome evaluated during the study was the microbiological cure of urogenital gonococcal infection, defined as a negative result of culture studies during the follow-up period, i.e. 10-17 days after the end of treatment. All study participants who came for a follow-up visit and who underwent a cultural study were included in the analysis according to the study protocol.

The average age of 401 eligible patients (GENT / AZI - 202; GEMI / AZI - 199) was 30 years. Most of the patients were heterosexual men (GENT / AZI 57%; GEMI / AZI 51%), then homosexuals (GENT / AZI 33%; GEMI / AZI 39%), the smallest in the study were women ( GENT / AZI 9%; GEMI / AZI 11%).

Mycobiological healing was performed in 100% of patients in the GENT / AZI group and in 99.5% of the GEMI / AZI group.

In the GENT / AZI group, the most common adverse events were mild or moderate nausea (27% of participants), diarrhea (19%), abdominal discomfort / pain (7%) and vomiting (7%). In the GEMI / AZI group, the most common adverse events were nausea (37%, including 8% moderately severe and severe nausea), diarrhea (23%) and abdominal discomfort / pain (11%).

Thus, the two therapeutic schemes studied were very effective in eradicating gonococci. At the same time, undesirable effects from the gastrointestinal tract, in particular nausea and diarrhea, have been noted quite often. The results of this study provide an alternative treatment for gonorrhea in patients who cannot use cephalosporins.

CDC experts note that these regimens will likely be included in future editions of the CDC guidelines for the treatment of STDs.