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Based on review of recent evidence, CDC recommends a single 500 mg intramuscular dose of ceftriaxone for uncomplicated gonorrhea. Treatment for coinfection with Chlamydia trachomatis with oral doxycycline (100 mg twice daily for 7 days) should be administered when chlamydial infection has not been excluded.
We compared the effectiveness of cefixime in eliminating N. gonorrhoeae infection at the 3 anatomical sites (urogenital, pharyngeal, and rectal). We performed the analysis separately by dosage (single cefixime dose of 400 or 800 mg).
This update provides the rationale for the change in gonorrhea treatment recommendations to a higher dose (500 mg) of ceftriaxone and removal of azithro-mycin from the recommended regimen.
INTRODUCTION. Gonococcal infections, including urethritis, cervicitis, epididymitis, and proctitis, are a significant cause of morbidity among sexually active men and women. The treatment of these sexually transmitted infections (STIs) has evolved over the years, mainly due to the emergence of antibiotic resistance.
Single-dose cefixime (400 mg po) is currently the only oral cephalosporin recommended as a primary treatment for gonorrhea. However, cefixime has not been marketed in the United States since October 2002 [ 16 ].
At present, the only CDC-recommended treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea is monotherapy with a single intramuscular dose of ceftriaxone 500 mg.
A single dose of 400 mg cefixime orally taken once coupled with 2 g of azithromycin is recommended as an alternative treatment option for uncomplicated gonorrhea. However, in patients where IM injection are contraindicated in conditions such as hemophilia, or patients under therapy with anticoagulants, it might prove as a useful alternative to ...
Our study results showed that an oral dose of 800 mg cefixime was inferior to a single IV dose of 1 g of ceftriaxone for the treatment of gonorrhea and chlamydia co-infection when both drugs were taken together with oral doxycycline 100 mg twice a day for 7 days.
The most significant change in the new guidelines is that CDC no longer recommends cefixime as an effective oral treatment for gonorrhea, leaving only injectable ceftriaxone to be used in combination with one of two oral antibiotics, either azithromycin or doxycycline.
Continued surveillance and trials are necessary to monitor and investigate resistance to ceftriaxone, cefixime, azithromycin, doxycycline and other treatments for N. gonorrhoeae. Trials should include both men and women, and members of key populations.