Take-Home Medications After Ceftriaxone and Azithromycin for Gonorrhea
No additional take-home medications are required after treatment with ceftriaxone 250-500 mg IM plus azithromycin 1 g orally as a single dose for uncomplicated gonorrhea. This is a complete, single-encounter treatment regimen. 1, 2
Understanding the Complete Treatment Regimen
The current CDC-recommended treatment consists of:
Both medications are administered at the same clinical visit, and no additional antibiotics are needed to take home unless specific circumstances apply. 1, 2
When Take-Home Medications ARE Required
If Chlamydia Has Not Been Excluded
- Doxycycline 100 mg orally twice daily for 7 days should be prescribed if concurrent chlamydial infection has not been ruled out and azithromycin was not given. 3
- However, the single-dose azithromycin 1 g already provides adequate chlamydia coverage, eliminating the need for doxycycline in most cases. 1
Alternative Regimens Requiring Take-Home Medications
If ceftriaxone is unavailable:
- Cefixime 400 mg orally (single dose) PLUS azithromycin 1 g orally (single dose) 4
- Both can be given at the visit, but mandatory test-of-cure at 1 week is required 4
If severe cephalosporin allergy:
- Azithromycin 2 g orally (single dose) 1, 5
- This is given at the visit with mandatory test-of-cure at 1 week 1, 5
Critical Clinical Pitfalls to Avoid
Do NOT Prescribe Doxycycline If Azithromycin 1g Was Given
- The single-dose azithromycin 1 g already provides adequate coverage for potential chlamydial coinfection. 1
- Adding doxycycline is redundant and increases unnecessary antimicrobial exposure. 3
Do NOT Prescribe Additional Antibiotics "Just in Case"
- Patients treated with the recommended ceftriaxone plus azithromycin regimen do not need routine test-of-cure unless symptoms persist. 1, 2
- The cure rate for this regimen is 99.1% for urogenital and anorectal gonorrhea. 1
Exception: Doxycycline Instead of Azithromycin
If the treatment was ceftriaxone 500 mg IM plus doxycycline (instead of azithromycin):
- Doxycycline 100 mg orally twice daily for 7 days must be prescribed as take-home medication. 4
- However, azithromycin is strongly preferred over doxycycline due to single-dose convenience and better compliance. 4, 1
Follow-Up Instructions (Not Medications)
Patients should be instructed to:
- Avoid sexual intercourse until therapy is completed and both patient and partners are asymptomatic. 1, 2
- Return if symptoms persist after treatment for culture and antimicrobial susceptibility testing. 1, 2
- Consider retesting at 3 months due to high reinfection risk (not treatment failure). 1
Partner Management
All sexual partners from the preceding 60 days should be treated with the same dual therapy regimen. 1, 2 If partners cannot access care promptly, expedited partner therapy with oral cefixime 400 mg plus azithromycin 1 g can be provided. 4, 1