Chapter 137. Gonococcal Infections (Part 8)

Gonococcal Infections: TreatmentTreatment 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) Chapter 137. Gonococcal Infections (Part 8) Gonococcal Infections: Treatment Treatment failure can lead to continued transmission and the emergence ofantibiotic resistance. The importance of adequate treatment with a regimen that thepatient will adhere to cannot be overemphasized. Thus highly effective single-doseregimens have been developed for uncomplicated gonococcal infections. Theupdated 2006 treatment guidelines for gonococcal infections from the Centers forDisease Control and Prevention are summarized in Table 137-1; therecommendations for uncomplicated gonorrhea apply to HIV-infected as well asHIV-uninfected patients. Table 137-1 Recommended Treatment for Gonococcal Infections: 2006Guidelines of the Centers for Disease Control and Prevention (Updated in2007) Diagnosis Treatment of Choice Uncomplicated gonococcalinfection 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, singleadult 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) cdrugs Continuation therapy Cefixime (400 mg PO bid) Meningitis or endocarditis See texth a True failure of treatment with a recommended regimen is rare and shouldprompt 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 pharyngealgonorrhea. 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 hasfrank arthritis with an effusion, or if the patient cannot be relied on to adhere totreatment. g All initial regimens should be continued for 24–48 h after clinicalimprovement begins, at which time therapy may be switched to one of thecontinuation regimens to complete a full week of antimicrobial treatment.Treatment for chlamydial infection (as above) should be given if this infection hasnot been ruled out. h ...