From the Guidelines
The recommended treatment for Neisseria gonorrhoeae is a dual therapy approach consisting of a single intramuscular injection of ceftriaxone 250 mg combined with oral azithromycin 1 gram as a single dose, as recommended by the CDC 1. This combination is necessary because of increasing antibiotic resistance in gonorrhea strains worldwide. The use of ceftriaxone and azithromycin provides a high cure rate and helps to prevent the development of further resistance. For patients with severe penicillin allergy, alternative regimens include gentamicin 240 mg intramuscularly plus azithromycin 2 grams orally in a single dose, as recommended by the US Centers for Disease Control and Prevention and the European guidelines 1. All sexual partners from the previous 60 days should be notified, tested, and treated regardless of symptoms to prevent reinfection. Patients should abstain from sexual activity for 7 days after completing treatment and until all partners have been treated. A test of cure is recommended in certain cases, particularly for pharyngeal infections or when using alternative regimens. The dual therapy approach targets the bacteria through different mechanisms - ceftriaxone disrupts bacterial cell wall synthesis while azithromycin inhibits protein synthesis - providing more complete eradication and helping prevent the development of further resistance. It is essential to follow the most recent guidelines, such as those from the CDC and the World Health Organization, to ensure effective treatment and prevent the spread of antibiotic-resistant strains 1.
From the FDA Drug Label
Uncomplicated gonococcal infections in adults (except anorectal infections in men):100 mg, by mouth, twice a day for 7 days. As an alternate single visit dose, administer 300 mg stat followed in one hour by a second 300 mg dose. Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae.
The recommended treatment for Neisseria (N.) Gonorrhoeae is:
- Doxycycline: 100 mg, by mouth, twice a day for 7 days 2
- Azithromycin: is also an option for the treatment of urethritis and cervicitis due to Neisseria gonorrhoeae 3 Key points:
- The treatment should be selected based on the severity of the infection and the patient's medical history.
- It is essential to follow the recommended dosage and duration of therapy to ensure effective treatment and prevent the development of antibiotic-resistant bacteria.
From the Research
Treatment for N. Gonorrhoeae
The recommended treatment for Neisseria (N.) Gonorrhoeae is as follows:
- A single 500 mg intramuscular (IM) dose of ceftriaxone for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea 4, 5.
- If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended 4, 5.
Alternative Treatments
- Azithromycin 2.0 g orally has been shown to be effective in the treatment of uncomplicated gonorrhea, but it is associated with a relatively high frequency of gastrointestinal side effects and is expensive 6.
- Cefixime and ceftriaxone are third-generation cephalosporins that have been used to treat gonorrhea, but decreased susceptibility of N. gonorrhoeae to these antibiotics has been reported 7.
Resistance and Treatment Failure
- N. gonorrhoeae has developed resistance to all first-line recommended therapies, making gonococcal antimicrobial resistance a major public health concern 5.
- There have been reports of ceftriaxone treatment failures internationally, and a case of possible gonorrhoea treatment failure with ceftriaxone plus azithromycin has been reported in Austria 8.
- Continued surveillance of gonococcal antimicrobial resistance is essential to prevent spread and ensure effective treatment 5, 7.