Procaine penicillin G in oil with 2% aluminum monostearate (PAM) in acute gonorrheal infection

ABSTRACT

1. Two sets of studies regarding the effect of PAM in acute gonorrheal infection in males were undertaken (a) a total of 437 cases (primary infection) using three dosage forms - 600,000 u (146 cases), 900,00 u (146 cases) and 1,200,000 u (145 cases) and (b) a total of 518 cases using two dosage forms - 1,200,000 u (263 cases) and 2,400,000 u (255 cases). Each dose was given in one single intramuscular injection at the buttocks except the 2,400,000 u which was given in two doses of 1,200,000 u at 24 hours interval2. Analysis of the data for the third day of observation after treatment shows that a higher dosage of 2,400,000 u of PAM gave the lowest percentage of positive results (4.31%) and those receiving lower dosages of 600,000 u (10.9%), 900,000 u (18.4%) and 1,200,000 u (average of the two studies - 6.5%) gave a higher percentage of positives3. The dosage of PAM in gonorrhea must be increased to produce a higher peak of penicillinemia to prevent the gonococcus from being less sensitive to the drug, and to prevent the occurrence of resistance4. Post-treatment observation is one of the problems in the evaluation of the penicillin treatment of gonorrhea as 36.15 per cent and 44.01 per cent of cases treated with PAM failed to return to the clinic for the follow-up and examination5. Smear and culture examination should be performed at the same time for the latter is more reliable as a criterion for cure6. Exposure to re-infection could not be entirely excluded from those positive cases during the period of observation after treatment, for a negative history of re-exposure obtained from the patient is not conclusive7. The use of alcohol even in moderate quantities inhibits the action of the drug resulting in persistence of the infection and tendency to develop relapses8. Alcohol (beer, wine, whisky or anything that contains even a little alcohol) must be absolutely avoided during the acute stage and for a period of 3-4 weeks after treatment. (Summary and Conclusions)