Treatment of Infections Due to Multiresistant Neisseria gonorrhoeae with Sulbactam/Ampicillin

Between January and April 1984, 229 of 448 male patients with urethritis at the Choong-Ku Venereal Disease Clinic in Seoul had positive urethral cultures: 66 for penicillinase-producing Neisseria gonorrhoeae (PPNG) and 163 for non-penicillinase-producing N. gonorrhoeae (non-PPNG). Forty-five men with PPNG urethritis were enrolled in a study of the efficacy of treatment with sulbactam/ampicillin plus probenecid. Diagnosis and evaluation of cure were based on culture results. The agar-plate dilution method was used for susceptibility testing, and the chromogenic cephalosporin test was used for detection of beta-lactamases. MICs of various antibiotics for the isolates were high. MICs of sulbactam/ampicillin were 0.25-4 micrograms/ml, with an MIC90 of 4 micrograms/ml, a value 16-fold lower than that for ampicillin alone (MIC90 greater than 32 micrograms/ml). Patients were treated with 1 g of probenecid orally and either one vial of sodium sulbactam/ampicillin or two vials intramuscularly. Each vial contained 0.5 g of sodium sulbactam and 1 g of sodium ampicillin. Patients were followed up for three to five days. All patients but one were cured, and no remarkable adverse reactions were noted. The two regimens of sulbactam/ampicillin were equally effective in the treatment of uncomplicated PPNG in men.