A comparison of penicillin G plus a beta-lactamase inhibitor (sulbactam) with spectinomycin for treatment of urethritis caused by penicillinase-producing Neisseria gonorrhoeae.

When combined with penicillin, sulbactam, a beta-lactamase inhibitor with weak intrinsic antibacterial activity, produces a marked synergistic effect in vitro against penicillinase-producing Neisseria gonorrhoeae. We compared a regimen of aqueous procaine penicillin G, sulbactam, and probenecid with spectinomycin for the treatment of uncomplicated gonococcal urethritis. Of 101 patients receiving the penicillin-sulbactam regimen, 97 (97%) were cured of their infection, as were 87 (95%) of 92 patients who received spectinomycin. Fifty per cent of patients were infected with penicillinase-producing N. gonorrhoeae; 43 (94%) of 46 treated with the penicillin-sulbactam regimen were cured as compared with 47 (92%) of 51 treated with spectinomycin. Neither regimen was associated with serious adverse effects. The results show that aqueous procaine penicillin G given with sulbactam and probenecid is an effective alternative for single-session therapy of urethritis caused by penicillinase-producing N. gonorrhoeae.