From the Guidelines
The recommended treatment dose of ceftriaxone for gonorrhea is 250 mg intramuscularly, typically in combination with azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days. This dose is effective for uncomplicated gonorrhea infections of the cervix, urethra, rectum, and pharynx, as supported by the Centers for Disease Control and Prevention (CDC) guidelines 1. The medication should be administered by a healthcare professional. For patients with severe beta-lactam allergy, alternative regimens such as gentamicin plus azithromycin may be considered. It's essential to note that treatment for gonorrhea often includes additional antibiotics to cover potential co-infection with chlamydia. Sexual partners from the previous 60 days should also be evaluated and treated. Patients should abstain from sexual activity for 7 days after treatment completion and until all partners have been treated. Ceftriaxone is highly effective against Neisseria gonorrhoeae because it inhibits bacterial cell wall synthesis, and the recommended dose ensures adequate tissue penetration while addressing concerns about emerging antimicrobial resistance.
Some key points to consider:
- The use of cefixime is no longer recommended as a first-line treatment due to declining susceptibility among N. gonorrhoeae isolates 1.
- Combination therapy with ceftriaxone and azithromycin or doxycycline is the most reliably effective treatment for uncomplicated gonorrhea.
- Patients with severe beta-lactam allergy require alternative treatment regimens.
- Treatment of gonorrhea should always consider the potential for co-infection with other sexually transmitted infections, such as chlamydia.
The CDC's guidelines, as outlined in the Morbidity and Mortality Weekly Report 1, provide the most recent and highest quality evidence for the treatment of gonorrhea, emphasizing the importance of combination therapy with ceftriaxone and another antibiotic to ensure effective treatment and prevent the spread of antimicrobial resistance.
From the FDA Drug Label
For the treatment of uncomplicated gonococcal infections, a single intramuscular dose of 250 mg is recommended. The recommended treatment dose of ceftriaxone for gonorrhea is 250 mg as a single intramuscular dose for uncomplicated gonococcal infections 2.
- Key points:
- The dose is for uncomplicated gonococcal infections.
- It is administered intramuscularly.
- The dose should not be exceeded without consulting the prescribing information for specific guidance.
From the Research
Gonorrhea Treatment with Ceftriaxone
- The recommended treatment dose of ceftriaxone for gonorrhea is a single 500 mg intramuscular dose, as indicated by the Centers for Disease Control and Prevention (CDC) in their updated guidelines 3.
- This dose is recommended for the treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea.
- In some studies, ceftriaxone has been compared to other treatments, such as gentamicin, and has shown high efficacy in clearing gonococcal infections 4, 5, 6.
- The use of ceftriaxone in combination with azithromycin has been evaluated, and while it is effective, the CDC now recommends a single dose of ceftriaxone due to concerns about antimicrobial resistance and stewardship 3.
Comparison with Other Treatments
- Ceftriaxone has been compared to gentamicin in several studies, with mixed results 4, 5, 6.
- In one study, gentamicin was found to be non-inferior to ceftriaxone for the treatment of rectal and pharyngeal gonorrhea 6.
- However, another study found that ceftriaxone was more effective than gentamicin in clearing gonococcal infections, particularly in patients with pharyngeal infections 4.