Low dose penicillin for gonococcal arthritis. A comparative therapy trial

D. E. Trentham, J. W. McCravey and A. T. Masi

Sixty-three patients with gonococcal arthritis completed a double-blind randomized penicillin therapy trial comparing a low dose regimen (procaine penicillin G, 600,000 units intramuscularly, given every 12 hours for up to ten days) with a high dose (the same procaine penicillin regimen and intravenous aqueous penicillin G, 10 million units daily, for the first three days). Pretherapy features were similar in the 36 patients allocated to low-dose vs the 27 to high-dose therapy. All patients had definite improvement within 48 hours of the initiation of either regimen. No therapeutic response variable studied differed significantly between the groups. Thus, no additional therapeutic benefit accrued from the high doses of penicillin. The absence of complications or failures in either treatment group indicate that gonococcal arthritis is ordinarily quite responsive to low doses of penicillin given intramuscularly, and that massive intravenous therapy is unnecessary.