For which Sexually Transmitted Disease (STD) is intramuscular ampicillin (Ampicillin) 500 milligrams indicated?

From the Guidelines

Intramuscular ampicillin 500 mg is not indicated as a first-line treatment for any Sexually Transmitted Disease (STD) due to widespread antimicrobial resistance, and current guidelines recommend ceftriaxone-based regimens as first-line therapy for gonorrhea. When considering the treatment of gonorrhea, it's essential to note that ampicillin was historically used, but its effectiveness has been compromised by increasing resistance patterns 1. The most recent and highest quality study, which is from 2012, does not recommend ampicillin as a treatment option for gonorrhea, instead suggesting ceftriaxone 250 mg intramuscularly and either azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days as the most reliably effective treatment for uncomplicated gonorrhea 1.

Some key points to consider when treating gonorrhea include:

• The importance of combination therapy to ensure treatment of co-occurring pathogens, such as Chlamydia trachomatis.
• The need for patients to be monitored for allergic reactions, particularly if they have a penicillin allergy history.
• The recommendation for additional testing for other STDs, as co-infections are common.
• The importance of follow-up testing to confirm cure, especially when using non-first-line therapies.

It's also worth noting that other studies, such as those from 2010 and 2002, provide guidance on the treatment of various STDs, including gonorrhea, but the most recent and highest quality study should be prioritized when making treatment decisions 1.

In terms of specific treatment options, ceftriaxone-based regimens are currently recommended as first-line therapy for gonorrhea, and patients should be advised to refer their sex partners for evaluation and treatment 1. Overall, the treatment of gonorrhea requires careful consideration of the most recent and highest quality evidence, as well as the potential for co-infections and the need for follow-up testing.

From the FDA Drug Label

Urethritis in males due to N. gonorrhoeae. Adults – Two doses of 500 mg each at an interval of 8 to 12 hours The indicated Sexually Transmitted Disease (STD) for intramuscular ampicillin (Ampicillin) 500 milligrams is Gonorrhea, specifically urethritis in males due to N. gonorrhoeae 2.

• The recommended dosage is two doses of 500 mg each at an interval of 8 to 12 hours.
• Treatment may be repeated if necessary or extended if required.
• In the treatment of complications of gonorrheal urethritis, such as prostatitis and epididymitis, prolonged and intensive therapy is recommended 2.

From the Research

Sexually Transmitted Disease (STD) Treatment

• The provided studies do not indicate that intramuscular ampicillin (Ampicillin) 500 milligrams is specifically recommended for any Sexually Transmitted Disease (STD) treatment.
• However, the studies suggest that ampicillin/sulbactam combinations are effective against gonorrhea, with cure rates ranging from 92% to 100% 3, 4, 5.
• Ceftriaxone is also recommended for the treatment of uncomplicated gonorrhea, with a single intramuscular dose of 500mg 6.
• The studies do not provide evidence for the use of intramuscular ampicillin (Ampicillin) 500 milligrams as a standalone treatment for any STD.

Gonorrhea Treatment

• Ampicillin/sulbactam combinations have been shown to be effective against gonorrhea, including penicillinase-producing Neisseria gonorrhoeae (PPNG) strains 3, 4, 5.
• Ceftriaxone is also effective against gonorrhea, with a single intramuscular dose of 125mg or 250mg 7, 6.
• The 2021 CDC STI Treatment Guidelines recommend 500mg ceftriaxone intramuscularly once for the treatment of uncomplicated gonorrhea at all anatomic sites 6.