From the Guidelines
Cefixime 400mg orally is no longer a recommended first-line treatment for uncomplicated gonorrhea due to increasing resistance, and ceftriaxone 250mg intramuscularly is the preferred treatment option, but if an oral alternative is necessary, azithromycin 2g orally as a single dose can be considered, although treatment failures are more common with oral alternatives than with ceftriaxone. When considering an oral antibiotic alternative to ceftriaxone for treating uncomplicated gonorrhea, it's essential to weigh the risks and benefits, taking into account the increasing antibiotic resistance.
- The most effective treatment for uncomplicated gonorrhea is ceftriaxone 250mg intramuscularly, which provides high and sustained bactericidal levels in the blood and is highly efficacious at all anatomic sites of infection for treatment of N. gonorrhoeae infections caused by strains currently circulating in the United States 1.
- Cefixime 400mg orally is no longer recommended as a first-line treatment due to increasing resistance, with 15 (0.1%) isolates having decreased susceptibility to cefixime from 2006 to 2011, and the emergence of fluoroquinolone-resistant N. gonorrhoeae in the United States during the 1990s also occurred initially in the West and predominantly among MSM before spreading throughout the United States within several years 1.
- Azithromycin 2g orally as a single dose can be considered as an oral alternative, although treatment failures are more common with oral alternatives than with ceftriaxone, and follow-up testing to confirm cure is recommended when using these alternatives 1.
- It's crucial to note that all sexual partners from the previous 60 days should be notified, tested, and treated regardless of which antibiotic regimen is used, and health-care providers must maintain the ability to collect specimens for culture and be knowledgeable of laboratories to which they can send specimens for culture to monitor antimicrobial resistance trends and determine susceptibility to guide treatment following treatment failure 1.
From the Research
Oral Antibiotic Alternatives to Ceftriaxone
There are oral antibiotic alternatives to ceftriaxone for treating uncomplicated gonorrhea. Some of the options include:
- Cefixime: a single dose of 400 or 800 mg given orally, which has been shown to be as effective as ceftriaxone in treating uncomplicated gonorrhea 2
- Azithromycin: a single dose of 1 g given orally, which has been identified as an effective oral antibiotic for the treatment of gonorrhea 3
Comparison of Oral and Injectable Antibiotics
Studies have compared the efficacy and safety of various antibiotic regimens, including oral and injectable antibiotics, for the treatment of gonorrhea. The results suggest that:
- Ceftriaxone is the most effective injectable antibiotic for the treatment of gonorrhea 3
- Azithromycin is the most effective oral antibiotic for the treatment of gonorrhea 3
- Cefixime is a safe and effective oral alternative to ceftriaxone for the treatment of uncomplicated gonorrhea 2
Other Treatment Options
Other treatment options for uncomplicated gonorrhea include:
- Cefotaxime: a single dose of 500 mg given intramuscularly, which has been shown to be a safe and cost-effective alternative to ceftriaxone 4, 5
- Doxycycline: a 7-day course of 100 mg given orally twice a day, which is recommended for concurrent treatment with ceftriaxone if chlamydial infection has not been excluded 6