From the Guidelines
The most effective oral antibiotic treatments for gonorrhea, chlamydia, and urinary tract infections (UTIs) are cefixime 400 mg as a single dose plus azithromycin 1 g as a single dose for gonorrhea, azithromycin 1.0–1.5 g as a single dose or doxycycline 100 mg twice daily for 7 days for chlamydia, and doxycycline 100 mg twice daily for 7 days or azithromycin 1.0–1.5 g as a single dose for UTIs caused by non-gonococcal infections, as recommended by the European Association of Urology guidelines 1.
When considering treatment options for these infections, it's crucial to take into account the rising concern of antibiotic resistance, particularly for gonorrhea, which may necessitate dual therapy 1. The European Association of Urology guidelines suggest the following oral antibiotic regimens:
- For gonococcal infection: cefixime 400 mg as a single dose plus azithromycin 1 g as a single dose 1
- For non-gonococcal infection (unidentified pathogen): doxycycline 100 mg twice daily for 7 days or azithromycin 500 mg on day 1,250 mg for 4 days 1
- For chlamydia: azithromycin 1.0–1.5 g as a single dose or doxycycline 100 mg twice daily for 7 days 1
It's also important to note that treatment of sexual partners is essential to prevent reinfection, and patients should abstain from sexual activity until treatment is complete and symptoms have resolved 1. For recurrent UTIs, longer treatment courses may be necessary, and underlying causes should be investigated. The guidelines also provide alternative regimens, such as gemifloxacin 320 mg as a single dose plus azithromycin 2 g as a single dose, or fosfomycin trometamol 3 g on days 1,3, and 5, for cases where the first-line treatments are not suitable 1.
From the FDA Drug Label
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 urinary tract infections caused by susceptible isolates of Escherichia coli and Proteus mirabilis. 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 best oral antibiotics for treating gonorrhea and urinary tract infections (UTIs) include Cefixime. However, for chlamydia, the FDA drug label does not provide direct information on the use of cefixime.
- Cefixime is recommended for the treatment of uncomplicated gonorrhea with a single oral dose of 400 mg.
- Cefixime is also recommended for the treatment of uncomplicated urinary tract infections with a dose of 400 mg daily. However, the FDA label does not provide information on the use of cefixime for chlamydia treatment. 2
From the Research
Oral Antibiotics for Gonorrhea, Chlamydia, and UTIs
The following oral antibiotics have been studied for the treatment of gonorrhea, chlamydia, and urinary tract infections (UTIs):
- Cefixime: a single dose of 400 mg or 800 mg has been shown to be effective in treating uncomplicated gonorrhea, with cure rates of 96% and 98%, respectively 3
- Azithromycin: a single dose of 2 g has been shown to be effective in treating uncomplicated gonorrhea, with a cure rate of 98.9% 4
- Doxycycline: 100 mg twice a day for 7 days has been recommended for concurrent treatment with ceftriaxone for uncomplicated urogenital, anorectal, and pharyngeal gonorrhea, if chlamydial infection has not been excluded 5
Combination Therapies
Combination therapies have also been studied:
- Cefixime 800 mg plus doxycycline 100 mg twice a day for 7 days has been compared to ceftriaxone 1 g plus azithromycin 2 g for the treatment of urogenital, rectal, and pharyngeal gonorrhea, with the combination of cefixime and doxycycline showing high efficacy for urogenital and rectal gonorrhea, but not achieving noninferiority to ceftriaxone and azithromycin for pharyngeal gonorrhea 6
- Ceftriaxone 250 mg plus azithromycin 1 g has been recommended in the past for the treatment of uncomplicated gonococcal infections, but the recommendation has been updated to a single 500 mg IM dose of ceftriaxone, with concurrent treatment with doxycycline if chlamydial infection has not been excluded 5
Resistance and Treatment Failures
There is increasing concern about antimicrobial resistance and treatment failures:
- Resistance to cefixime and azithromycin has been reported, with cases of clinical failure to cefixime and azithromycin in England in 2010 7
- The emergence of ceftriaxone resistance is a concern, and continued monitoring through surveillance and health care providers' reporting of treatment failures is essential to ensuring the continued efficacy of recommended regimens 5