From the Guidelines
Gentamicin is not typically recommended as a first-line treatment for sexually transmitted infections (STIs), but it can be used as an alternative option for gonorrhea at a dose of 240mg intramuscular injection as a single dose, usually combined with azithromycin 2g orally in a single dose, as stated in a recent study published in The Lancet Infectious Diseases 1. For most STIs, the recommended treatments are ceftriaxone 500mg IM for gonorrhea, doxycycline 100mg twice daily for 7 days for chlamydia, and benzathine penicillin G for syphilis. Some key points to consider when treating STIs include:
- Gentamicin is not effective against chlamydia, syphilis, or viral STIs like herpes, HIV, or HPV.
- Gentamicin carries risks of nephrotoxicity and ototoxicity, especially with repeated dosing, making it less suitable for routine STI treatment.
- Proper STI management also requires partner notification, testing for other concurrent STIs, and follow-up testing to ensure cure.
- When treating STIs, it's essential to use guideline-recommended antibiotics to ensure effective treatment and prevent antimicrobial resistance, as highlighted in various studies and guidelines, including those from the Centers for Disease Control and Prevention 1. It's also important to note that the prevalence of azithromycin resistance varies substantially in different regions, and gentamicin might not always be a suitable alternative, as mentioned in the study published in The Lancet Infectious Diseases 1. Overall, the use of gentamicin for STIs should be guided by the most recent and highest-quality evidence, and clinicians should consider the potential risks and benefits, as well as the specific circumstances of each patient.
From the Research
Gentamicin for STIs
- Gentamicin has been studied as a potential treatment for gonorrhea, with some evidence suggesting it may be effective as a second-line agent 2.
- However, the highest quality evidence suggests that gentamicin is not noninferior to ceftriaxone for treatment of gonorrhea, and its efficacy for extragenital gonorrhea is unclear 2.
- The Centers for Disease Control and Prevention (CDC) recommend ceftriaxone as the first-line treatment for gonorrhea, with doxycycline added for coinfection with chlamydia 3, 4.
- Gentamicin is not recommended as a first-line treatment due to concerns about resistance and side effects, such as ototoxicity and nephrotoxicity 5, 6.
- Alternative antibiotics, such as ceftriaxone and doxycycline, are preferred for the treatment of STIs, including gonorrhea and chlamydia 3, 4.
Side Effects and Limitations
- Gentamicin has been associated with serious side effects, including ototoxicity and nephrotoxicity, which can be debilitating and permanent 5, 6.
- The risk of gentamicin-induced ototoxicity and nephrotoxicity should be carefully considered before using this antibiotic, especially in patients with preexisting conditions or susceptibility to these side effects 5, 6.
Treatment Guidelines
- The CDC recommends ceftriaxone 500mg intramuscularly once for the treatment of uncomplicated gonorrhea at all anatomic sites, with doxycycline 100mg twice daily for 7 days added for coinfection with chlamydia 3, 4.
- Gentamicin-based regimens should be reserved for second-line treatment of urogenital and extragenital gonorrhea infections, and only used when alternative antibiotics are not suitable 2.