Chapter 137. Gonococcal Infections (Part 8)

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Gonococcal Infections: Treatment Treatment failure can lead to continued transmission and the emergence of antibiotic resistance. The importance of adequate treatment with a regimen that the patient will adhere to cannot be overemphasized. Thus highly effective single-dose regimens have been developed for uncomplicated gonococcal infections. The updated 2006 treatment guidelines for gonococcal infections from the Centers for Disease Control and Prevention are summarized in Table 137-1; the recommendations for uncomplicated gonorrhea apply to HIV-infected as well as HIV-uninfected patients. ...

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Chapter 137. Gonococcal Infections (Part 8) Gonococcal Infections: Treatment Treatment failure can lead to continued transmission and the emergence of antibiotic resistance. The importance of adequate treatment with a regimen that the patient will adhere to cannot be overemphasized. Thus highly effective single-dose regimens have been developed for uncomplicated gonococcal infections. The updated 2006 treatment guidelines for gonococcal infections from the Centers for Disease Control and Prevention are summarized in Table 137-1; the recommendations for uncomplicated gonorrhea apply to HIV-infected as well as HIV-uninfected patients. Table 137-1 Recommended Treatment for Gonococcal Infections: 2006 Guidelines of the Centers for Disease Control and Prevention (Updated in 2007)
Diagnosis Treatment of Choice Uncomplicated gonococcal infection of the cervix, urethra, pharynx, or rectuma First-line regimens Ceftriaxone (125 mg IM, single dose) or Cefixime (400 mg PO, single dose) plus Treatment for Chlamydia if chlamydial infection is not ruled out: Azithromycin (1 g PO, single dose) or
Doxycycline (100 mg PO bid for 7 days) Alternative regimens Ceftizoxime (500 mg IM, single dose) or Cefotaxime (500 mg IM, single dose) or Spectinomycin (2 g IM, single dose)b,c or Cefotetan (1 g IM, single dose) plus probenecid (1 g PO, single dose)b or Cefoxitin (2 g IM, single dose) plus probenecid (1 g PO, single dose)b
Epididymitis See Chap. 124 Pelvic inflammatory disease See Chap. 124 Gonococcal conjunctivitis in an Ceftriaxone (1 g IM, single adult dose)d Ophthalmia neonatorume Ceftriaxone (25–50 mg/kg IV, single dose, not to exceed 125 mg) Disseminated gonococcal infectionf Initial therapyg Patient tolerant of β-lactam Ceftriaxone (1 g IM or IV q24h;
drugs recommended) or Cefotaxime (1 g IV q8h) or Ceftizoxime (1 g IV q8h) Patients allergic to β-lactam Spectinomycin (2 g IM q12h) c drugs Continuation therapy Cefixime (400 mg PO bid) Meningitis or endocarditis See texth a True failure of treatment with a recommended regimen is rare and should prompt an evaluation for reinfection or consideration of an alternative diagnosis. b Spectinomycin, cefotetan, and cefoxitin, which are alternative agents, currently are unavailable or in short supply in the United States.
c Spectinomycin may be ineffective for the treatment of pharyngeal gonorrhea. d Plus lavage of the infected eye with saline solution (once). e Prophylactic regimens are discussed in the text. f Hospitalization is indicated if the diagnosis is uncertain, if the patient has frank arthritis with an effusion, or if the patient cannot be relied on to adhere to treatment. g All initial regimens should be continued for 24–48 h after clinical improvement begins, at which time therapy may be switched to one of the continuation regimens to complete a full week of antimicrobial treatment. Treatment for chlamydial infection (as above) should be given if this infection has not been ruled out. h Hospitalization is indicated to exclude suspected meningitis or endocarditis.