Background The development of resistance to multiple antimicrobials has limited treatment options for gonorrhoea. Potential emergence of cephalosporin resistance in Neisseria gonorrhoeae and cephalosporin allergy in some patients make it necessary to evaluate the effectiveness of other available antimicrobials. Gentamicin is widely available in the USA and is used for gonorrhoea treatment in several countries.

Methods We conducted a systematic review of the medical literature to assess the effectiveness of gentamicin for treatment of uncomplicated urogenital gonococcal infections. Two reviewers assessed relevant articles and independently selected studies that met pre-specified selection criteria (including systematic enrolment and assignment to treatment and culture-confirmed diagnosis and outcome). Summary measures for selected studies were pooled using inverse variance-weighted averages with fixed effects. Heterogeneity was assessed using I-squared, which estimates proportion (from 0% to 100%) of variability attributable to heterogeneity between studies. Pooled percentage with negative follow-up culture was compared with CDC criteria for selection of recommended therapy (>95% efficacy with lower 95% CI >95%).

Results 18 potentially relevant English-language studies were identified; three met inclusion criteria. Reviewer agreement for initial judgement on meeting selection criteria was substantial (κ 0.68). Two studies used 240 mg, and one study used 280 mg IM gentamicin. Percentages with negative culture after single-dose treatment were 90.7% (n=86), 91.4% (n=220), and 95.0% (n=40). Pooled percentage with negative culture after single-dose treatment was 91.5% (95% CI 88.1% to 94.0%, I-squared = 0%).

Conclusions Gentamicin does not meet current CDC criteria for recommended treatment of gonorrhoea. However, if cephalosporin resistance emerges, gentamicin may be a useful alternative agent. Evaluation of additional regimens, including combination therapy, is warranted.