What is the recommended treatment regimen for gonorrhoea?

From the Guidelines

The recommended treatment regimen for gonorrhea is dual antibiotic therapy, consisting of a single intramuscular injection of ceftriaxone 250mg, combined with oral azithromycin 1g as a single dose, as this approach has been shown to be the most reliably effective treatment for uncomplicated gonorrhea 1.

Key Considerations

• The treatment of gonorrhea has been complicated by the ability of Neisseria gonorrhoeae to develop antimicrobial resistance, making dual therapy necessary to ensure complete eradication and prevent further resistance development.
• The use of cefixime is no longer recommended as a first-line treatment due to declining susceptibility among N. gonorrhoeae isolates 1.
• Combination therapy with ceftriaxone and azithromycin or doxycycline is recommended to treat co-occurring pathogens, such as Chlamydia trachomatis.

Treatment Approach

• Patients should receive a single intramuscular injection of ceftriaxone 250mg, combined with oral azithromycin 1g as a single dose.
• Alternative regimens, such as gentamicin 240mg intramuscularly plus azithromycin 2g orally as single doses, may be considered for patients with severe penicillin allergy.
• Sexual partners from the previous 60 days should also receive treatment, regardless of their test results, to prevent reinfection.

Follow-up and Test-of-Cure

• 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 1-2 weeks after treatment completion, particularly for pharyngeal infections which are more difficult to eradicate.
• If symptoms persist after treatment, patients should return for re-evaluation as this may indicate treatment failure or reinfection 1.

From the FDA Drug Label

For the treatment of uncomplicated gonococcal infections, a single intramuscular dose of 250 mg is recommended. The recommended treatment regimen for gonorrhoea is a single intramuscular dose of 250 mg of ceftriaxone 2.

• The dose is administered via intramuscular injection.
• No dosage adjustment is necessary for patients with impairment of renal or hepatic function.

From the Research

Gonorrhoea Treatment Regimens

The recommended treatment regimen for gonorrhoea involves a combination of antibiotics to combat the increasing problem of antimicrobial resistance in Neisseria gonorrhoeae 3. The key points to consider are:

• Combination therapy is recommended to delay the onset of treatment failures 3.
• Ceftriaxone plus azithromycin is a commonly recommended regimen, but there have been reports of treatment failures with this combination 4.
• Alternative regimens, such as gentamicin plus azithromycin, have shown promise in in vitro studies 3, 5.
• The Centers for Disease Control and Prevention (CDC) recommends 500mg ceftriaxone intramuscularly once for the treatment of uncomplicated gonorrhea, with cotreatment with doxycycline if coinfection with chlamydia has not been excluded 6.

Antibiotic Susceptibility

The susceptibility of Neisseria gonorrhoeae to various antibiotics is a critical factor in determining the effectiveness of treatment regimens. Key findings include:

• Reduced susceptibility or resistance to cephalosporins and azithromycin is increasing 4, 7.
• Ceftriaxone and azithromycin remain effective against most isolates, but resistance is a growing concern 7, 6.
• Doxycycline resistance is common, with 100% of isolates showing reduced susceptibility or resistance in one study 7.

Treatment Guidelines

The CDC has developed guidelines for the treatment of gonorrhea, taking into account the latest evidence on antimicrobial resistance and treatment failures 6. The guidelines recommend:

• Ceftriaxone plus azithromycin as the first-line treatment for uncomplicated gonorrhea.
• Cotreatment with doxycycline if coinfection with chlamydia has not been excluded.
• Alternative regimens for persons with cephalosporin allergies, although options are limited.