A new study has failed to establish the non-inferiority of gentamicin to ceftriaxone for treating gonorrhoea. The findings were published in Lancet.
The G-ToG (Gentamicin in the Treatment of Gonorrhoea) was a parallel-group, pragmatic, randomised, non-inferiority trial conducted at 14 sexual health clinics across England. Patients were randomly assigned to two groups, each receiving gentamicin 240 mg (n=358) or ceftriaxone 500 mg (n=362) as a single intramuscular dose. Both groups also received a single 1 g dose of oral azithromycin. The primary outcome was a complete clearance of Neisseria gonorrhoeae at all sites with initial infection, determined using a nucleic acid amplification test conducted two weeks after treatment.
After two weeks of treatment, 98 per cent of patients in the ceftriaxone group vs 91 per cent in the gentamicin group achieved complete infection clearance (adjusted risk difference, –6.4%; 95% CI, –10.4% to –2.4%). Among those with a genital infection, 98 per cent in the ceftriaxone group and 94 per cent in the gentamicin group achieved clearance (adjusted risk difference, –4.4%; 95% CI, –8.7 to 0). Among those with a pharyngeal infection, 96 per cent in the ceftriaxone group vs 80 per cent in the gentamicin group achieved clearance (adjusted risk difference, –15.3%; 95% CI, –24.0 to –6.5). Similarly, among those with a rectal infection, 98 per cent in the ceftriaxone group vs 90 per cent in the gentamicin group achieved clearance (adjusted risk difference, –7.8%; 95% CI, –13.6 to –2.0).
The authors suggest that while gentamicin may not be an appropriate first-line agent for the treatment of gonorrhoea, it may still be beneficial for patients with isolated genital infection, patients allergic or intolerant to ceftriaxone, or those carrying a ceftriaxone-resistant isolate.