Gonococci that resist standard penicillin regimens by production of a penicillinase are now well established in certain areas of the world. Because cefoxitin, a semisynthetic cephamycin, resists gonococcal penicillinase in vitro, we compared procaine penicillin G and cefoxitin in treatment of gonorrhea in an area where 40 per cent of isolates produce penicillinase. One hundred and seven men with culture-proved gonococcal urethritis were given a single dose of either procaine penicillin G, 4.8 million U, or cefoxitin, 2 g, intramuscularly. Both groups took 1 g of probenecid orally; cefoxitin was given with lidocaine to reduce pain at the injection site. In men infected with penicillinase-negative gonococci, both cefoxitin and penicillin were highly effective. Penicillin failed in 77 per cent of men with penicillinase-positive strains, whereas cefoxitin was completely successful. Cefoxitin is an effective alternative to spectinomycin for single-session therapy of urethritis caused by penicillinase-producing Neisseria gonorrhoeae. (N Engl J Med 301:509–511, 1979) IN 1976 the Center for Disease Control identified the first penicillinase-producing Neisseria gonorrhoeae.1 These strains contain the plasmid that codes for an enzyme that inactivates penicillin by opening the beta-lactam ring.2 Such strains have subsequently become widely distributed3 and constitute more than 40 per cent of isolates in some areas of the world.4 In contrast to gonococci with chromosomally-mediated relative resistance to penicillin, which can be overcome by increased doses of antibiotic, most penicillinase-producing strains are not eradicated by standard high-dose penicillin regimens. Spectinomycin is the only drug that has produced acceptable cure rates against penicillin-resistant gonococci.5,6 Because of. © 1979, Massachusetts Medical Society. All rights reserved.
