Rifadin (rifampicin) in the treatment of gonorrhoea in Uganda. A controlled trial.

A number of recent surveys have shown an alarmingly high incidence of diminished penicillin sensitivity among strains of Neisseria gonorrhoeae isolated in About 80 per cent. of gonococcal strains from the Kampala area show diminished sensitivity to penicillin at the present time, and such strains also exhibit slightly diminished sensitivity to tetracycline and total resistance to streptomycin (Phillips and others, 1969; Arya and Phillips, 1970). Phillips and others (1969) also observed links in the sensitivity pattern between penicillin and other unrelated antibiotics-notably erythromycin, chlor-amphenicol, and gentamycin. Similar links have also been described elsewhere (If conditions and practices responsible for the decline in usefulness of penicillin and other drugs are allowed to continue, then we may be 'witnessing the emergence of a multiple-resistant gonococcus' (Phillips and others, 1969) at least in this part of the world with a very high incidence of gonorrhoea. Moreover we are already reaching the limit of the amount of procaine penicillin (2-4 mega units) that can reasonably be given in one injection. For these reasons it is important to search for alternative drugs. Rifadin (rifampicin), a semi-synthetic oral antibiotic, has already been reported to give satisfactory results (Willcox, Morrison, and Cobbold, 1970), and no toxic effects were reported with the dosage used. It was therefore decided to evaluate this drug in a population with a high incidence of gonorrhoea and very amenable to follow up (Arya and Phillips, 1970). Material and methods PATIENTS 254 male university students suffered 357 attacks of urethritis (gonococcal and nongonococcal) between August, 1969, and July, 1970. 66 patients had their first-ever attack of urethritis during this study; the rest (i.e. 188 patients) had already had one to eight attacks of urethritis during their stay in the university. 327 attacks of urethritis seen and treated by one of us (O.P.A.) formed the basis of this study. LABORATORY INVESTIGATIONS Gram-stained urethral smears were made in all cases, and cultures in 279 cases. Gonorrhoea was diagnosed if characteristic Gram-negative bean-shaped intracellular diplococci were seen and/or if gonococci were grown on culture. Nongonococcal urethritis was diagnosed if such organisms were neither seen nor grown. Disc-diffusion sensitivity tests to Rifadin were performed on chocolate agar cultures; the discs were supplied by Lepetit Pharmaceuticals, Nairobi (Kenya branch). Minimum inhibitory concentrations of penicillin were determined as described by Arya and Phillips (1970), with the exception that the Oxford staphylococcus was used instead of W.H.O. reference strains. Blood samples …