Effectiveness of gentamicin for gonorrhoea treatment: systematic review and meta-analysis.

OBJECTIVES The development of resistance to multiple antimicrobial agents has limited treatment options for gonorrhoea. The potential emergence of cephalosporin resistance in Neisseria gonorrhoeae and cephalosporin allergy in some patients make it necessary to evaluate the effectiveness of other available antimicrobial agents. Gentamicin is widely available in the USA and is used for gonorrhoea treatment in several countries. We conducted a systematic review of the medical literature to assess the effectiveness of gentamicin for treatment of uncomplicated urogenital gonococcal infections. METHODS Two reviewers assessed relevant articles and independently selected studies that met prespecified selection criteria (including systematic enrolment and assignment to treatment and culture-confirmed diagnosis and outcome). Summary measures for selected studies were pooled using inverse variance-weighted averages with fixed effects. Heterogeneity was assessed using I(2), which estimates proportion (0-100%) of variability attributable to heterogeneity between studies. Pooled percentage with negative follow-up culture was compared with Centers for Disease Control and Prevention (CDC) criteria for selection of recommended therapy (lower 95% CI of efficacy ≥95%). RESULTS Twenty-nine potentially relevant studies were identified; three met inclusion criteria. Two studies used 240 mg intramuscular gentamicin and one used 280 mg. Percentages with negative culture after single-dose treatment were 90.7% (n=86), 91.4% (n=220) and 95.0% (n=40). Pooled percentage with negative culture after single-dose treatment was 91.5% (95% CI 88.1% to 94.0%, I(2)=0%). CONCLUSIONS Gentamicin does not meet current CDC criteria for recommended treatment of gonorrhoea. However, if cephalosporin resistance emerges, gentamicin may be a useful alternative agent. Evaluation of additional regimens, including combination therapy, is warranted.