Cefixime Cure Rate for Gonorrhea
Cefixime 400 mg orally as a single dose achieves a cure rate of 97.4% for uncomplicated urogenital and anorectal gonorrhea, making it an effective oral alternative to intramuscular ceftriaxone, though it provides lower and less sustained bactericidal levels. 1
Historical Efficacy Data
The CDC guidelines from 2002 established cefixime 400 mg as a recommended first-line regimen based on clinical trial data showing:
- 97.4% cure rate for uncomplicated urogenital and anorectal infections 1
- 96% overall cure rate (89 of 93 patients) in a major randomized trial comparing it to ceftriaxone 2
- 98% cure rate in another comparative study (118 of 121 evaluable patients) 3
- 97% bacteriologic eradication (105 of 108 patients) in a third trial 4
These cure rates are slightly lower than ceftriaxone's 99.1% efficacy but still meet the therapeutic threshold of >95% for first-line treatment. 1
Comparative Performance
Urogenital and Rectal Sites
Cefixime performs well at these anatomic sites, with cure rates consistently above 96% across multiple studies. 2, 3, 4 The drug maintains efficacy regardless of antimicrobial resistance patterns, including against penicillinase-producing N. gonorrhoeae (PPNG) and tetracycline-resistant strains (TRNG). 2, 4
Pharyngeal Infections
For pharyngeal gonorrhea, cefixime shows 91% efficacy (20 of 22 patients cured), which is acceptable but less robust than urogenital sites. 2 This is an important consideration since pharyngeal infections are notoriously difficult to eradicate. 1
Pharmacodynamic Limitations
The critical caveat is that cefixime 400 mg does not provide as high or sustained bactericidal blood levels as ceftriaxone 125 mg IM. 1, 5 Pharmacodynamic analysis shows cefixime maintains free drug concentrations above the MIC90 for 22-50 hours, which is adequate but represents the lower end of the therapeutic window. 6
Clinical Advantages
- Oral administration eliminates the need for injection, improving patient acceptance and ease of delivery 1, 2
- Well-tolerated with self-limiting gastrointestinal side effects in only 10% of patients 4
- Cost-effective compared to injectable alternatives 2
Important Caveats
Resistance Concerns
While cefixime was effective against resistant strains in earlier studies 2, 4, ongoing surveillance is critical as cephalosporin resistance patterns evolve. 1 The lower bactericidal levels compared to ceftriaxone theoretically provide less margin for emerging resistance. 6
Availability Issues
Cefixime 400 mg tablets were unavailable in the United States from 2002-2008, which limited its use during that period. 7 Clinicians should verify current availability in their region.
Chlamydia Co-treatment
Cefixime does not treat concurrent chlamydial infection, which persists in at least 50% of co-infected patients. 2 Always add azithromycin 1 g orally or doxycycline 100 mg twice daily for 7 days unless chlamydia is ruled out. 1
Not for Complicated Infections
These cure rates apply only to uncomplicated urogenital, anorectal, and pharyngeal infections. 1 For disseminated gonococcal infection or other complications, parenteral ceftriaxone is required.
Current Treatment Context
While cefixime remains an effective oral option with a 97.4% cure rate, ceftriaxone 125 mg IM achieves 99.1% cure rates and provides superior pharmacodynamics. 1 In settings where injection is feasible, ceftriaxone is preferred. However, when oral therapy is necessary or injection is not practical, cefixime 400 mg remains a valid choice with documented efficacy above the 95% threshold for first-line therapy.