From the Guidelines
The treatment of choice for gonorrhea and chlamydia is combination therapy with ceftriaxone 250 mg intramuscularly and either azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days.
Treatment Rationale
- The CDC recommends this combination therapy as the most reliably effective treatment for uncomplicated gonorrhea 1.
- Ceftriaxone is a cephalosporin antibiotic that is effective against gonorrhea, while azithromycin or doxycycline are effective against chlamydia.
- Concomitant therapy with a regimen effective against chlamydia is recommended because of the frequency of dual infections 1.
- Azithromycin can be given as single-dose, directly observed therapy, and may be the more cost-effective drug in many settings, especially in persons who are unlikely to complete the 7-day doxycycline regimen 1.
Key Considerations
- Gonorrhea treatment has been complicated by the ability of Neisseria gonorrhoeae to develop resistance to antimicrobials used for treatment 1.
- Cefixime is no longer recommended as a first-line regimen for treatment of gonococcal infections due to declining susceptibility 1.
- Routine dual therapy without testing for chlamydia can be cost-effective for populations in which chlamydial infection accompanies 10%--30% of gonococcal infections 1.
From the Research
Treatment of Gonorrhea and Chlamydia
The treatment of choice for gonorrhea and chlamydia involves the use of antibiotics. According to the studies, the recommended treatment for uncomplicated gonorrhea is:
- A single 500 mg intramuscular dose of ceftriaxone 2, 3
- If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended 2, 3
Alternative Treatments
For patients with cephalosporin allergies, alternative therapies may be considered, but there are no recommended alternative therapies for N gonorrhoeae infection of the throat 2.
Treatment of Chlamydia
The treatment of chlamydia typically involves the use of azithromycin or doxycycline 4, 5, 6. Azithromycin is considered a first-line drug for the treatment of chlamydial infections, along with doxycycline 6.
Antimicrobial Resistance
It's essential to note that antimicrobial resistance is a significant concern in the treatment of gonorrhea and chlamydia. The studies highlight the importance of monitoring for the emergence of ceftriaxone resistance and the need for antimicrobial stewardship 2, 3.