From the FDA Drug Label
For the treatment of uncomplicated gonococcal infections, a single intramuscular dose of 250 mg is recommended. The recommended treatment for gonorrhea in pregnant women is not explicitly stated in the drug label, but for uncomplicated gonococcal infections in adults, a single intramuscular dose of 250 mg of ceftriaxone is recommended 1.
- Key Considerations:
- The label does not provide specific guidance for pregnant women.
- The standard treatment dose for uncomplicated gonococcal infections is 250 mg.
- It is essential to consult a healthcare professional for proper diagnosis and treatment, especially in pregnant women.
From the Research
The recommended treatment for gonorrhea in pregnant women is ceftriaxone 500 mg as a single intramuscular injection. This antibiotic is considered safe during pregnancy and is highly effective against Neisseria gonorrhoeae, the bacterium that causes gonorrhea, as supported by the most recent guidelines 2. For women with severe penicillin allergy, consultation with an infectious disease specialist is recommended as alternative options are limited. It's essential that sexual partners also receive treatment to prevent reinfection, and patients should abstain from sexual activity until both they and their partners have completed treatment and symptoms have resolved. Follow-up testing should be performed 3-4 weeks after treatment to confirm cure. Untreated gonorrhea during pregnancy can lead to serious complications, including preterm birth, premature rupture of membranes, and transmission to the newborn during delivery, potentially causing eye infections (ophthalmia neonatorum). Ceftriaxone is preferred because many strains of gonorrhea have developed resistance to other antibiotics, making this third-generation cephalosporin the most reliable treatment option currently available.
Some key points to consider in the treatment of gonorrhea in pregnant women include:
- The importance of prompt and effective treatment to prevent complications and transmission to the newborn
- The need for sexual partners to receive treatment to prevent reinfection
- The recommendation for follow-up testing to confirm cure
- The potential for severe complications if gonorrhea is left untreated during pregnancy
The most recent guidelines from the CDC 2 support the use of ceftriaxone 500 mg as a single intramuscular injection for the treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea. This recommendation is based on the increasing concern for antimicrobial stewardship and the potential impact of dual therapy on commensal organisms and concurrent pathogens. The guidelines also recommend concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) if chlamydial infection has not been excluded.
It's worth noting that other studies have evaluated the effectiveness of different treatment regimens for gonorrhea, including cefixime and spectinomycin 3, as well as the in vitro activity of antimicrobial combinations against clinical isolates of N. gonorrhoeae 4. However, the most recent and highest quality study 2 supports the use of ceftriaxone 500 mg as a single intramuscular injection for the treatment of gonorrhea in pregnant women.