Intrmuscular Injection of Procaine Penicillin Combined with Oral Administration of Ampicillin in the Treatment of Gonorrhoea.

Because of the increase in strains of N. gonorrhoeae relatively resistant to penicillin and the subsequent rise in treatment failures (Gjessing and Odegaard, 1964), we decided to modify our previous treatment of males (one injection of 600,000 units procaine penicillin). Neither repeated smaller doses of procaine penicillin nor administration of a single large dose seemed to give satisfactory results. Epstein (1959) had 20 per cent. failures after five daily injections of 600,000 units procaine penicillin. Willcox (1963a) found failure rates of 5 to 10 per cent. after one dose of 1 * 2 mega units procaine penicillin, and Rantasalo (1963) had about 9 per cent. failures when the infection was caused by strains with highly decreased sensitivity and the treatment was a single dose of 3 mega units procaine penicillin. At present the substitution of other injectable drugs for procaine penicillin cannot be recommended for routine treatment without reservation (Willcox, 1962; Laird, 1963). From a psychological and epidemiological point of view, oral administration of drugs is open to serious objections. The method is too convenient for the patients and could lead to a general belief that gonorrhoea can be cured merely by taking tablets. There are also other objections, well expressed by Willcox (1963a): "Not only do patients vary in their powers of absorption of orally administered drugs, but those with venereal diseases are notoriously unreliable in taking their medicines at the times and in the doses required. The danger also remains that unused tablets may be reserved for self-medication at a later date or may even be sold on the 'blackmarket' ". Our experience is the same and it requires little imagination to see that widespread and uncontrolled oral medication could lead to chaos. We decided, therefore, to try a combination of intramuscular injection and oral administration under supervision. It was considered advantageous to continue with 600,000 units procaine penicillin as an injection, chiefly because this has been our routine treatment for some years, and it still has a very good effect on strains sensitive to penicillin. For oral administration ampicillin was chosen. Ampicillin has a better effect in vitro on gonococci than the three other oral penicillins-propicillin, phenethicillin, and penicillin V (Odegaard, 1960; 1962)-and it was suggested (Odegaard, 1962) that it might be of value in the treatment of gonorrhoea. Willcox (1963b) showed that ampicillin is very effective in the treatment of gonorrhoea, and Alergant (1963) found that it was a suitable alternative to penicillin by injection. It was also observed that ampicillin could be used to cure patients with relapse following routine treatment with procaine penicillin (Gjessing and Odegaard, 1964).