What is better for gonorrhea, Clindamycin or Augmentin?

Neither Clindamycin nor Augmentin Should Be Used for Gonorrhea

Neither clindamycin nor Augmentin (amoxicillin-clavulanate) are appropriate treatments for gonorrhea, and using either would constitute medical malpractice given current antimicrobial resistance patterns. 1, 2

The Only Recommended Treatment

The CDC recommends ceftriaxone 250-500 mg intramuscularly PLUS azithromycin 1 g orally as the only first-line regimen for gonorrhea treatment. 3, 1, 4 This dual therapy achieves a 99.1% cure rate for uncomplicated urogenital and anorectal gonorrhea. 1, 2

Why Neither Drug Works

Clindamycin

• Clindamycin has no activity against Neisseria gonorrhoeae and is not mentioned in any gonorrhea treatment guidelines. 3, 1
• This antibiotic lacks coverage for gram-negative organisms like N. gonorrhoeae.

Augmentin (Amoxicillin-Clavulanate)

• N. gonorrhoeae has developed widespread resistance to penicillins, making all penicillin-based antibiotics ineffective. 4, 5, 6
• Penicillin resistance in gonorrhea is so extensive that penicillins were abandoned as treatment options decades ago. 4

Critical Resistance Patterns

• N. gonorrhoeae has sequentially developed resistance to sulfonamides, tetracyclines, penicillins, and quinolones. 4, 5, 6
• Fluoroquinolones (ciprofloxacin) are explicitly contraindicated despite historical 99.8% cure rates due to widespread resistance. 1, 2
• Even oral cephalosporins (cefixime) are no longer first-line agents due to documented treatment failures in Europe. 1

Alternative Regimens (When Ceftriaxone Unavailable)

If ceftriaxone is truly unavailable:

• Cefixime 400 mg orally PLUS azithromycin 1 g orally with mandatory test-of-cure at 1 week. 3, 1

For severe cephalosporin allergy:

• Azithromycin 2 g orally (not 1 g) with mandatory test-of-cure at 1 week. 3, 1, 7
• Gentamicin 240 mg IM PLUS azithromycin 2 g orally (100% cure rate in trials). 1, 2

Critical Pitfalls

• Never use azithromycin 1 g alone - it has only 93% efficacy and is explicitly contraindicated as monotherapy. 1, 7, 2
• Pharyngeal gonorrhea is particularly difficult to eradicate and requires ceftriaxone for reliable cure, as most treatment failures involve pharyngeal sites. 1, 2
• All sexual partners from the preceding 60 days must be evaluated and treated with the same dual therapy regimen. 3, 1, 2

Test-of-Cure Requirements

• Patients treated with recommended ceftriaxone-based regimens do not need routine test-of-cure. 4, 5, 6
• Mandatory test-of-cure at 1 week is required for all alternative regimens (cefixime, azithromycin monotherapy, gentamicin). 3, 1, 7
• All patients should be retested at 3 months due to high reinfection rates. 4, 5, 6