What are the treatment options for gonorrhea in a patient with a penicillin (pcn) allergy?

From the Guidelines

For patients with a penicillin allergy who have gonorrhea, the recommended treatment is a single 125–250 mg intramuscular dose of ceftriaxone, as it has minimal cross-reactivity with penicillin allergies and is generally safe for most penicillin-allergic patients 1. When considering treatment options for gonorrhea in patients with a penicillin allergy, it's crucial to prioritize alternatives that are effective and have a low risk of cross-reactivity.

• Ceftriaxone is a preferred option due to its efficacy and safety profile, even in patients with a history of penicillin allergy, as noted in the guideline on antimicrobial therapy of sexually transmitted diseases 1.
• Other options like ciprofloxacin and levofloxacin are not recommended due to the spread of quinolone-resistant N. gonorrhoeae, and their use must be undertaken with caution 1.
• Azithromycin can be considered as an alternative, but its use in HIV-infected persons has not been well-studied and should be approached with caution 1.
• It's also important to consider the site of infection, as ceftriaxone is particularly effective for pharyngeal gonorrhea, where other regimens may have lower efficacy.
• Dual therapy with doxycycline may be added to treat potential co-infection with chlamydia and to help prevent resistance development, although the use of doxycycline in HIV-infected persons also requires caution 1.

From the FDA Drug Label

1. 8 Use in Sexually Transmitted Infections Azithromycin, at the recommended dose, should not be relied upon to treat syphilis. Antibacterial agents used to treat non-gonococcal urethritis may mask or delay the symptoms of incubating syphilis All patients with sexually transmitted urethritis or cervicitis should have a serologic test for syphilis and appropriate testing for gonorrhea performed at the time of diagnosis.

2. 9 Development of Drug-Resistant Bacteria Prescribing azithromycin in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.

The treatment options for gonorrhea in a patient with a penicillin allergy are not directly stated in the provided drug labels. However, azithromycin is mentioned in the context of sexually transmitted infections, but it is not explicitly recommended for gonorrhea treatment in the provided text.

• Ciprofloxacin is not mentioned as a treatment for gonorrhea in the provided drug label. Given the lack of direct information, no conclusion can be drawn about the specific treatment options for gonorrhea in a patient with a penicillin allergy based on the provided drug labels 2 3.

From the Research

Treatment Options for Gonorrhea in Patients with Penicillin Allergy

• Patients with a penicillin allergy can be treated with alternative antibiotics, as the cross-reactivity between penicillin and other beta-lactam antibiotics is minimal 4
• Ceftriaxone is a commonly used treatment for gonorrhea, and patients with a non-anaphylactic penicillin allergy can receive this medication at a rate of 92.3% 4
• Other treatment options for gonorrhea in patients with penicillin allergy include:
  • Gentamicin plus azithromycin, which has been shown to be highly effective in treating urogenital gonorrhea 5
  • Gemifloxacin plus azithromycin, which has also been shown to be highly effective in treating urogenital gonorrhea 5
  • Trospectomycin sulphate, which has been compared to ceftriaxone in the treatment of uncomplicated gonorrhea and found to be effective 6
  • Spectinomycin, which is a broad-spectrum aminocyclitol antibiotic that is highly effective in the treatment of uncomplicated gonorrhea, especially in areas where penicillinase-producing strains of Neisseria gonorrhoeae are prevalent 7

Considerations for Treatment

• Patients with a penicillin allergy are more likely to receive alternative antibiotics beyond cephalosporins or azithromycin 4
• The choice of treatment should be based on the severity of the allergy and the presence of other medical conditions 4
• Ceftriaxone may be a good option for patients with a non-anaphylactic penicillin allergy, but other treatments may be necessary for patients with a more severe allergy 4, 8