From the Guidelines
The recommended empiric treatment for gonorrhea in males is ceftriaxone 250 mg as a single intramuscular dose plus azithromycin 1 g orally as a single dose, as this combination is the most reliably effective treatment for uncomplicated gonorrhea, according to the CDC's 2012 guidelines 1. This recommendation is based on the increasing resistance of Neisseria gonorrhoeae to multiple antibiotic classes, including cephalosporins, and the importance of dual therapy in preventing further resistance development and treating potential co-infection with chlamydia, which occurs in approximately 30-50% of gonorrhea cases. Key points to consider in the treatment of gonorrhea include:
- The use of ceftriaxone and azithromycin as the first-line treatment regimen, due to their high efficacy and the low rate of resistance to these antibiotics 1
- The importance of testing for other sexually transmitted infections, including HIV, syphilis, and hepatitis, and treating them accordingly
- The need for follow-up testing 1-2 weeks after treatment to confirm cure, especially given the increasing antibiotic resistance patterns
- The recommendation for patients to abstain from sexual activity for 7 days after treatment completion and until all sexual partners have been treated
- The consideration of alternative regimens, such as cefixime 400 mg orally plus azithromycin 1 g orally, if ceftriaxone is not available, but with the caveat that cefixime is no longer recommended as a first-line treatment due to increasing resistance 1
From the FDA Drug Label
1.5 Uncomplicated Gonorrhea (cervical/urethral) Cefixime for oral suspension and cefixime capsule is indicated in the treatment of adults and pediatric patients six months of age or older with uncomplicated gonorrhea (cervical/urethral) caused by susceptible isolates of Neisseria gonorrhoeae(penicillinase-and non-penicillinase-producing isolates). 2.1 Adults The recommended dose of cefixime is 400 mg daily. This may be given as a 400 mg capsule daily. For the treatment of uncomplicated cervical/urethral gonococcal infections, a single oral dose of 400 mg is recommended.
The empiric oral treatment for gonorrhea (Neisseria gonorrhoeae infection) in males is cefixime, and the recommended dose is a single oral dose of 400 mg 2.
From the Research
Empiric Oral Treatment for Gonorrhea in Males
The empiric oral treatment for gonorrhea (Neisseria gonorrhoeae infection) in males includes:
- Cefixime: a single dose of 400 mg or 800 mg orally, with cure rates of 96% and 98% respectively 3
- Azithromycin: a single dose of 2.0 g orally, with a cure rate of 98.9% 4
- Other oral antibiotics such as cefuroxime axetil (1 g) and cefpodoxime proxetil (200 mg) may also be effective, but with lower cure rates 5
Comparison of Oral Antibiotics
A systematic review and network meta-analysis found that azithromycin was the most effective oral antibiotic for the treatment of gonorrhea, with a p score of 0.8633 6
- Cefixime was also found to be effective, with a cure rate of 95% in a study of 125 patients with uncomplicated gonorrhea 7
- Lower doses of cefixime, such as 200 mg, may also be effective, but are not recommended for routine treatment 7
Resistance and Safety
The efficacy of oral antibiotics may be affected by the presence of antimicrobial resistance, with some studies finding that certain antibiotics are less effective against resistant strains of Neisseria gonorrhoeae 3, 4