California Gonorrhea Treatment Guidelines
Recommended regimens for treatment of uncomplicated gonococcal infections of the urethra and rectum:
Ceftriaxone 250 mg IM in a single dose
OR, if ceftriaxone is not available,
Cefixime 400 mg orally in a single dose
Azithromycin 1 g orally in a single dose
Perhaps the most important set of changes in the 2010 STD Treatment Guidelines is related to treatment for gonorrhea. Because of concerns about antimicrobial resistance to cephalosporins, and for greater efficacy of treatment of pharyngeal infections, three changes regarding recommended treatment have been made:
- Ceftriaxone is the preferred antimicrobial agent;
- The dose of ceftriaxone for uncomplicated anogenital gonorrhea infections is increased to 250 mg intramuscular (IM) from 125 mg IM; and
- Dual therapy is recommended for all suspected and confirmed cases of gonorrhea.
Ceftriaxone (Rocephin) 250 mg IM (an increase from the previous dose recommendation of 125 mg) is now the preferred recommended antimicrobial agent for gonorrhea treatment. An oral dose of cefixime 400 mg remains an option, but does not provide as high nor as sustained a bactericidal level as that provided by ceftriaxone 250 mg.
Though cefixime can be administered orally, this advantage is offset by the limited efficacy of cefixime (as well as other oral cephaloporins) for treating gonococcal infections of the pharynx. Therefore, although cefixime 400 mg is included as a treatment option for gonorrhea in the CDC guidelines, medical sites in California should make every effort to provide ceftriaxone 250 mg as their first-line treatment regimen for gonorrhea.
Additionally, in an effort to slow the continuing development of antimicrobial-resistant Neisseria gonorrhoeae, dual therapy is now recommended, with either azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice daily for seven days (see diagram below). Dual therapy is recommended regardless of whether ceftriaxone or cefixime is prescribed, and regardless of chlamydia test result. Please refer to pages 50-51 of the Guidelines for further discussion of and rationale for these changes to gonorrhea treatment recommendations.