From the Guidelines
The recommended treatment for gonorrhea and chlamydia involves a dual antibiotic approach, 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, as the most reliably effective treatment for uncomplicated gonorrhea, as per the CDC's updated recommendations 1.
Key Considerations
- The treatment approach is based on the CDC's updated guidelines, which take into account the increasing resistance of Neisseria gonorrhoeae to certain antibiotics.
- Ceftriaxone is the preferred treatment for gonorrhea, while azithromycin or doxycycline is recommended for chlamydia.
- The dual antibiotic approach is necessary to treat both infections simultaneously, as they often occur together.
- Partners from the past 60 days should also be treated to prevent reinfection.
- Patients should abstain from sexual activity until treatment is complete and symptoms have resolved, typically for 7 days after treatment.
Rationale
- The CDC's updated recommendations are based on data from the Gonococcal Isolate Surveillance Project (GISP), which shows a decline in cefixime susceptibility among urethral N. gonorrhoeae isolates in the United States 1.
- The use of ceftriaxone and azithromycin or doxycycline is supported by studies that demonstrate their effectiveness in treating uncomplicated gonorrhea and chlamydia, respectively 1.
- The dual antibiotic approach is cost-effective and can help prevent the development of antimicrobial-resistant N. gonorrhoeae 1.
Important Notes
- Follow-up testing is recommended 3 months after treatment to confirm cure, especially important given rising antibiotic resistance.
- These infections are bacterial in nature, with gonorrhea caused by Neisseria gonorrhoeae and chlamydia by Chlamydia trachomatis, and both can cause serious complications including pelvic inflammatory disease and infertility if left untreated.
From the FDA Drug Label
- 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). Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae.
Treatment for Gonorrhea and Chlamydia:
- Cefixime is indicated for the treatment of uncomplicated gonorrhea (cervical/urethral) caused by susceptible isolates of Neisseria gonorrhoeae 2.
- Azithromycin is indicated for the treatment of urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae 3. Key Points:
- Cefixime is effective against Neisseria gonorrhoeae.
- Azithromycin is effective against Chlamydia trachomatis and Neisseria gonorrhoeae.
- The recommended dose of cefixime for uncomplicated gonorrhea is a single oral dose of 400 mg 2.
- The recommended dose of azithromycin for urethritis and cervicitis is not specified in the provided text, but it is indicated for the treatment of these conditions 3.
From the Research
Treatment Options for Gonorrhea and Chlamydia
- The Centers for Disease Control and Prevention (CDC) recommends a single 500 mg intramuscular dose of ceftriaxone for the treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea 4.
- If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended 4, 5.
- A study comparing the efficacy of high-dose intravenous ceftriaxone and oral cefixime combined with doxycycline for the treatment of Chlamydia trachomatis and Neisseria gonorrhoeae co-infection found that both regimens were highly effective in treating gonorrhea, but ceftriaxone was superior for the treatment of co-infection 6.
- Another study found that a single dose of cefixime (400 or 800 mg) given orally was as effective as the currently recommended regimen of ceftriaxone (250 mg given intramuscularly) for the treatment of uncomplicated gonorrhea 7.
Alternative Treatment Options
- For patients with cephalosporin allergies, there are no recommended alternative therapies for N gonorrhoeae infection of the throat 5.
- Azithromycin may be preferable as the second agent to treat gonorrhea, although doxycycline seems to be a reasonable alternative 8.
- A study found that retreatment rates for uncomplicated gonorrhea infection were not related to the treatment regimen (ceftriaxone plus azithromycin or ceftriaxone plus doxycycline) 8.
Antimicrobial Resistance
- Neisseria gonorrhoeae has developed resistance to all first-line recommended therapies, making gonococcal antimicrobial resistance a major public health concern 5.
- The Gonococcal Isolate Surveillance Project (GISP) data suggest that ceftriaxone minimal inhibitory concentrations (MICs) have remained stable in the United States, but there has been a rapid rise in the proportion of isolates with an elevated MIC to azithromycin 5.