From the Guidelines
Cefixime is not recommended as a first-line treatment for post-exposure prophylaxis (PEP) against gonorrhea due to increasing antibiotic resistance patterns, and instead, doxycycline postexposure prophylaxis (doxy PEP) is recommended for certain high-risk populations. The use of cefixime as a single 400 mg oral dose may not provide sufficient bactericidal levels to effectively prevent gonorrhea, especially in light of rising cefixime MICs 1. In contrast, doxy PEP has been shown to reduce syphilis, chlamydia, and gonorrhea infections by approximately 50% in high-risk populations, such as men who have sex with men (MSM) and transgender women (TGW) 1.
Key Considerations
- Doxy PEP is recommended for MSM and TGW who have had a bacterial STI diagnosed in the past 12 months, with a dose of 200 mg taken within 72 hours after sex 1.
- Cefixime may still be considered in settings where injectable medications like ceftriaxone are unavailable or impractical, but its use should be cautious due to increasing resistance patterns 1.
- Patients should undergo follow-up testing 1-2 weeks after PEP to confirm effectiveness, and common side effects of doxy PEP include gastrointestinal symptoms 1.
Recommendations
- Doxycycline postexposure prophylaxis (doxy PEP) is the preferred option for PEP against gonorrhea in high-risk populations, due to its demonstrated efficacy and potential to delay the emergence of resistance to cephalosporins 1.
- Cefixime should not be used as a first-line treatment for PEP against gonorrhea, due to increasing antibiotic resistance patterns and limited efficacy for treatment of pharyngeal gonorrhea 1.
From the Research
Cefixime for Post-Exposure Prophylaxis (PEP) Against Gonorrhea
- Cefixime is an orally absorbed cephalosporin that is active against Neisseria gonorrhoeae, including strains resistant to penicillin or tetracycline 2.
- The efficacy of cefixime in the treatment of uncomplicated gonorrhea has been demonstrated in several studies, with cure rates ranging from 93% to 98% 2, 3, 4, 5.
- Cefixime has been compared to ceftriaxone, another effective treatment for gonorrhea, and has been shown to be equally effective in some studies 2, 5.
- However, the use of cefixime as a single dose for PEP against gonorrhea is not explicitly mentioned in the provided studies.
- The studies primarily focus on the treatment of uncomplicated gonorrhea, rather than PEP.
Treatment Regimens
- A single dose of 400 mg or 800 mg of cefixime has been shown to be effective in the treatment of uncomplicated gonorrhea 2.
- Cefixime 200 mg has also been studied, but it is not recommended for routine treatment due to the risk of selecting resistant strains of Neisseria gonorrhoeae 4.
- Ceftriaxone 250 mg intramuscularly is also an effective treatment for gonorrhea, and may be preferred in some cases 3, 6.