From the Guidelines
Gonorrhea should be treated with a combination of ceftriaxone 250 mg intramuscularly and either azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days, as recommended by the CDC 1. This treatment approach is based on the most recent and highest quality evidence, which highlights the importance of combination therapy to improve treatment efficacy and potentially delay the emergence and spread of resistance to cephalosporins. The use of ceftriaxone as a single intramuscular injection of 250 mg provides high and sustained bactericidal levels in the blood and is highly efficacious at all anatomic sites of infection for treatment of N. gonorrhoeae infections caused by strains currently circulating in the United States 1. Some key points to consider when treating gonorrhea include:
- Completing the full course of antibiotics even if symptoms improve before finishing treatment
- Abstaining from sexual activity until both the patient and their partner(s) have completed treatment and are confirmed cured to prevent reinfection
- Notifying and treating all recent sexual partners, even if they don't have symptoms, as gonorrhea can be asymptomatic
- Follow-up testing is recommended 1-2 weeks after completing treatment to ensure the infection is gone
- Antibiotic resistance in gonorrhea is increasing, which is why treatment guidelines have changed over time and why it's essential to be treated by a healthcare professional rather than attempting self-treatment 1. In cases of suspected ceftriaxone treatment failure, alternative regimens such as intramuscular gentamicin 240 mg and one dose of azithromycin 2 g orally may be considered 1.
From the FDA Drug Label
1.5 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). 2.1 Adults The recommended dose of cefixime is 400 mg daily. This may be given as a 400 mg capsule daily. For the treatment of uncomplicated cervical/urethral gonococcal infections, a single oral dose of 400 mg is recommended.
Treatment of Gonorrhea:
- The recommended dose of cefixime is a single oral dose of 400 mg for the treatment of uncomplicated cervical/urethral gonococcal infections in adults 2.
- Alternatively, doxycycline can be used as an alternative drug in the treatment of uncomplicated gonorrhea caused by Neisseria gonorrhoeae, when penicillin is contraindicated 3.
From the Research
Treatment Options for Gonorrhea
- The current recommended treatment for gonorrhea is a single 500 mg intramuscular (IM) dose of ceftriaxone 4.
- If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended 4.
- Dual therapy with ceftriaxone and azithromycin is also recommended for the treatment of gonorrhea 5, 6.
- Azithromycin in combination with gentamicin or spectinomycin has been recommended in treatment failure cases 5.
Alternative Treatment Options
- For patients with cephalosporin allergies, there are limited alternative therapies available 7.
- No recommended alternative therapies exist for N gonorrhoeae infection of the throat 7.
- Other dual combinations, such as gentamicin+ertapenem, moxifloxacin+ertapenem, spectinomycin+ertapenem, azithromycin+ moxifloxacin, and cefixime+gentamicin, have shown synergistic effects and may be considered for future treatment 5.
Importance of Antimicrobial Stewardship
- The rise of antimicrobial resistance in Neisseria gonorrhoeae makes it essential to prioritize antimicrobial stewardship 7.
- The use of dual therapy and alternative treatment options should be carefully considered to prevent the development of resistance 5, 4, 7.
- Regular monitoring of treatment failures and antimicrobial resistance is crucial to ensuring the continued efficacy of recommended regimens 4, 7.