From the Guidelines
Treatment for persistent Gonococcal urethritis after Ofloxacin therapy should be switched to an alternative antibiotic regimen, such as ceftriaxone 125 mg IM in a single dose, or cefixime 400 mg orally in a single dose. This is due to the potential resistance of N. gonorrhoeae to fluoroquinolones, including ofloxacin 1.
- The recommended regimens for uncomplicated gonococcal infections, including urethritis, are cefixime 400 mg orally in a single dose, or ceftriaxone 125 mg IM in a single dose 1.
- If chlamydial infection is not ruled out, azithromycin 1 g orally in a single dose, or doxycycline 100 mg orally twice a day for 7 days, should be added to the treatment regimen 1.
- It is essential to obtain a recent travel history, including histories from sex partners, to ensure appropriate antibiotic therapy, as resistance to fluoroquinolones is expected to continue to spread 1.
- Clinicians should perform culture and susceptibility testing of relevant clinical specimens and report the case to the local health department if a patient has persistent gonococcal infection after treatment with a recommended regimen 1.
From the FDA Drug Label
- 5 Uncomplicated Gonorrhea (cervical/urethral) Cefixime for oral suspension and cefixime capsule is indicated in the treatment of adults and pediatric patients six months of age or older with uncomplicated gonorrhea (cervical/urethral) caused by susceptible isolates of Neisseria gonorrhoeae(penicillinase-and non-penicillinase-producing isolates).
The treatment for persistent Gonococcal (Neisseria gonorrhoeae) urethritis after Ofloxacin therapy is not directly addressed in the provided drug label for cefixime. However, cefixime is indicated for the treatment of uncomplicated gonorrhea (cervical/urethral) caused by susceptible isolates of Neisseria gonorrhoeae.
- Key points:
- Cefixime is effective against Neisseria gonorrhoeae
- The label does not explicitly address persistent gonococcal urethritis after Ofloxacin therapy
- The label does indicate cefixime is used for uncomplicated gonorrhea Since the label does not directly address the question of treatment for persistent gonococcal urethritis, no conclusion can be drawn from this label alone 2.
From the Research
Treatment for Persistent Gonococcal Urethritis
The treatment for persistent gonococcal urethritis after Ofloxacin therapy is not directly stated in the provided studies. However, the following information can be gathered:
- The recommended treatment for gonococcal urethritis is a single dose of ceftriaxone 250mg intramuscularly, plus a regimen active against Chlamydia trachomatis and nongonococcal urethritis 3.
- Dual therapy with ceftriaxone and azithromycin is the only recommended first-line regimen for the treatment of gonorrhea in the United States 4.
- For patients who receive recommended treatment and do well, no follow-up cultures are needed. However, patients with persistent or recurrent symptoms require careful re-evaluation of the patient, documentation of urethritis, and retreatment with antimicrobial agents a second time if urethritis is documented by positive cultures or increased numbers of polymorphonuclear leucocytes in urethral secretions 3.
- First-line treatment for gonococcal urethritis consists of a single dose of ceftriaxone/azithromycin combined therapy 5.
- Some studies suggest that cefixime, cefodizime, cefotaxime, cefoxitin, ceftizoxime, ceftriaxone, cefuroxime, cefuroxime axetil, ciprofloxacin, fleroxacin, norfloxacin, ofloxacin, pefloxacin, temafloxacin, azithromycin, aztreonam, netilmicin, rifampin plus erythromycin stearate, sisomicin, and spectinomycin are effective against gonococcal infections 6.
Key Points to Consider
- The choice of treatment should be based on the results of microbiological investigations to avoid the risk of persistence, recurrence, or reinfection 5.
- Empirical treatments are no longer recommended, and a broad spectrum of antibiotic therapy may be initiated while awaiting the results from pathogens' microbiological characterization 5.
- Sexual abstinence of at least 7 days should be observed from the start of treatment to avoid reinfection, while sexual partners should also be treated 5.
- The use of nucleic acid amplification test (NAAT) is mandatory in the clinical approach to the disease to determine the pathogens involved in the infection process and to initiate specific therapies accordingly 5.