title: Effectiveness of norfloxacin and ofloxacin for treatment of gonorrhoea and decrease of in vitro susceptibility to quinolones over time in Rwanda.
abstract: OBJECTIVE
  To study the effectiveness of single-dose norfloxacin and ofloxacin in the treatment of gonococcal urethritis in men, and to monitor in vitro antimicrobial susceptibility to these antibiotics over time.
  
  
  METHODS
  Centre Médico-Social de Bilyogo, Kigali, Rwanda. The only clinic in Rwanda using quinolones for the treatment of gonorrhoea.
  
  
  METHODS
  As part of a monitoring programme, men with gonococcal urethritis were evaluated after treatment with norfloxacin (800 mg) in 1986 and 1987, and after treatment with ofloxacin (400 mg) in 1989.
  
  
  RESULTS
  Neisseria gonorrhoeae was eradicated from the urethra from 96.0% (189/197) and from 97.1% (166/171) men treated with norfloxacin and ofloxacin, respectively. Overall 38.2% of the pretreatment isolates produced penicillinase (PPNG isolates) and 20.4% (44/216) of the tested non-PPNG isolates were chromosomally resistant to penicillin (MIC > or = 2.0 mg/l). Resistance to tetracycline and thiamphenicol was common in both PPNG and non-PPNG and increased considerably in 1989. All isolates were susceptible to kanamycin, spectinomycin, ceftiaxone, norfloxacin, ofloxacin and ciprofloxacin. However, a higher number of isolates recovered in 1989 showed decreased susceptibility to the quinolones. Treatment failure occurred more often in subjects with isolates having MIC values > or = 0.06 mg/L of norfloxacin (p = 0.006). Seven out of 13 patients who did not respond to therapy had no signs nor symptoms of urethritis.
  
  
  CONCLUSIONS
  Quinolone antibiotics are now indicated as a first line treatment of gonorrhoea in countries with a problem of antimicrobial multiresistance. However, antimicrobial susceptibility to the quinolones may decrease rapidly, and close monitoring of the in vitro susceptibility of N gonorrhoeae and the clinical effectiveness of the antibiotics is imperative.
authors.affiliation: Centre Hospitalier De Kigali.
authors.forename: J
authors.initials: J
authors.lastname: Bogaerts
authors.forename: W M
authors.initials: WM
authors.lastname: Tello
authors.forename: J
authors.initials: J
authors.lastname: Akingeneye
authors.forename: V
authors.initials: V
authors.lastname: Mukantabana
authors.forename: E
authors.initials: E
authors.lastname: Van Dyck
authors.forename: P
authors.initials: P
authors.lastname: Piot
mesh_terms: D000284:Administration, Oral; D000328:Adult; D004352:Drug Resistance, Microbial; D006069:Gonorrhea / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D008297:Male; D009344:Neisseria gonorrhoeae / Q000187:drug effects / Q000302:isolation & purification*; D009643:Norfloxacin / Q000008:administration & dosage / Q000627:therapeutic use*; D015242:Ofloxacin / Q000008:administration & dosage / Q000627:therapeutic use*; D012432:Rwanda; D016896:Treatment Outcome
chemical_list: D015242:Ofloxacin; D009643:Norfloxacin