Active Ingredients: Ciprofloxacin
Some providers use azithromycin for the treatment of adolescent gonorrhea infection. A single 2-g azithromycin dose is effective in the treatment of uncomplicated gonorrhea infection, but the high frequency of gastrointestinal side effects and the high cost prohibit its practical use.
The CDC's 1998 Guidelines for Treatment of Sexually Transmitted Diseases recommended the use of either 2 fluoroquinolone antimicrobials or 2 cephalosporins for the treatment of uncomplicated gonorrhea infection.
Among these recommended regimens, ciprofloxacin, a fluoroquinolone antibiotic, is one of the most affordable.
Quinolone-induced arthropathy has been demonstrated in all immature animal species tested, including dogs, rabbits, rats, and guinea pigs.
The effect on cartilage varies by animal species, age, quinolone type, and dose. Dogs are more susceptible to cartilage damage than other animal species, such as the rat. Young, skeletally immature animals primarily develop quinolone arthropathy.
In juvenile beagle dogs, the period of maximal susceptibility corresponds to the period of maximal growth.
Most data have not demonstrated damage to older dogs. Although a study demonstrated microscopic adult cartilage changes after 12 months of continuous treatment with perfloxacin, a more arthropathic quinolone, we found no data that have attempted to demonstrate ciprofloxacin-induced cartilage toxicity in an adult animal.
Ofloxacin produces damage at lower doses than ciprofloxacin. Higher fluoroquinolone doses produce more extensive articular damage.
Clinically, the fluoroquinolone-associated cartilage toxicity in animal models has mainly been seen in large, weight-bearing joints. Affected dogs become lame, with sporadic synovial effusion after 1—7 days of quinolone treatment.
In addition, affected dogs exhibit an altered standing posture characterized by hyperextension of weight-bearing joints. Histopathologic damage, such as blisters, fissures, and erosions accompanied by joint effusions, and MRI abnormalities are correlated with clinical findings.
Randomisation to vaccine group and antibiotic treatment was implemented using the computerised randomisation software Sortition Nuffield Department of Primary Care, Clinical Trials Unit, University of Oxford Study B was an observational challenge-re-challenge study.
Typhi or S.
Antibiotic allocation in Study B was not randomised. Following the availability of preliminary results from Study A—and under the guidance of the Data Safety Monitoring Committee—the protocol was amended such that first-line treatment was changed to ciprofloxacin 500 mg twice daily.
Written informed consent was obtained from all volunteers before enrolment.
Inclusion and exclusion criteria have previously been described. Typhi Quailes strain, diagnostic criteria for typhoid fever, and clinical assessment were identical between studies, and were carried out as previously described.
Briefly, participants were reviewed daily in an outpatient setting for two-weeks following oral challenge.
Solicited symptoms of typhoid fever and twice-daily self-measured oral temperatures were recorded by participants on an electronic diary for 21 days inclusive of the two-week challenge period. Antibiotic treatment was commenced if participants were diagnosed with typhoid fever, based on pre-specified composite criteria S.
Diagnosed participants attended between four to seven additional daily visits after commencing antibiotics to assess treatment response. Antibiotic allocation was unblinded.