What is the oral version of ceftriaxone (Ceftriaxone)?

Oral Alternative to Ceftriaxone for Gonorrhea Treatment

Cefixime 400 mg is the oral equivalent of ceftriaxone for treating gonorrhea, though it doesn't achieve the same high or sustained bactericidal levels as injectable ceftriaxone. 1

Comparison of Cefixime and Ceftriaxone

Efficacy

• Cefixime (oral):

  • 400 mg single dose cures 97.1-97.4% of uncomplicated urogenital and anorectal gonococcal infections 1
  • Main advantage is oral administration
  • Does not provide as high or sustained bactericidal levels as ceftriaxone

• Ceftriaxone (injectable):

  • 125 mg IM single dose cures 98.9-99.1% of uncomplicated urogenital and anorectal infections 1
  • Provides sustained, high bactericidal levels in blood
  • Gold standard for gonorrhea treatment

Clinical Decision Algorithm

1. First-line treatment (when oral therapy preferred):

   • Cefixime 400 mg orally in a single dose
   • Plus treatment for chlamydia if not ruled out (azithromycin 1g orally or doxycycline 100mg twice daily for 7 days)

2. When to use ceftriaxone instead:

   • Pharyngeal gonorrhea (cefixime less effective)
   • Areas with high antimicrobial resistance
   • When maximum efficacy is required

Other Oral Options (Less Preferred)

• Quinolones (ciprofloxacin 500mg, ofloxacin 400mg, levofloxacin 250mg):

  • No longer universally recommended due to resistance
  • Should not be used for infections in men who have sex with men or in patients with travel history to areas with quinolone-resistant N. gonorrhoeae 1

• Other oral cephalosporins (less data available):

  • Cefpodoxime and cefuroxime axetil have been studied but don't meet minimum efficacy criteria for all infection sites 1

Important Considerations

• Cefixime has been shown to be nearly as effective as ceftriaxone in clinical trials, with cure rates of 96-98% compared to 98% for ceftriaxone 2, 3

• When treating gonorrhea, always consider:

  1. Local resistance patterns
  2. Anatomical site of infection (pharyngeal infections are harder to eradicate)
  3. Need for concurrent chlamydia treatment
  4. Patient's ability to tolerate oral medication

• Caveat: While azithromycin 2g orally is effective against gonorrhea, it's not recommended due to gastrointestinal side effects and cost concerns 1, 4

Follow-Up

Patients treated with recommended regimens for uncomplicated gonorrhea generally don't need test of cure. However, if symptoms persist, culture and susceptibility testing should be performed 1.