AS A PHARMACIST, you will see BIG changes in gonorrhea treatment. Ceftriaxone 250 mg IM plus azithromycin 1 g orally has been recommended for years to try to slow gonorrhea resistance and cover possible chlamydia coinfection. But ceftriaxone 250 mg may not be a high-enough dose and azithromycin resistance continues to rise. That's why updated CDC guidelines now recommend ceftriaxone monotherapy for gonorrhea at a higher dose...
Give one dose of ceftriaxone 500 mg IM if patients weigh under 150 kg or 1 g for those 150 kg or more. Feel comfortable giving the dose IV if the patient has IV access.
For chlamydia coinfection, add doxycycline 100 mg orally BID for 7 days INSTEAD of one dose of azithromycin 1 g. But consider challenges. For example, test results often aren't available before emergency department (ED) discharge. And patients may not fill a prescribtion after leaving or have a way for you to contact them with test results. If these are concerns and you suspect chlamydia, consider sticking with one azithromycin dose instead of using doxycycline. Also continue to use azithromycin to treat chlamydia in pregnant patients or others who can't take doxycycline.
Urge partners to be seen, ceftriaxone is the most effective option for gonorrhea. Otherwise, they'll need a prescribtion for one dose of oral cefixime 800 mg instead of 400 mg per previous guidelines PLUS doxycycline for chlamydia if needed. Educate patients to abstain from sexual activity during treatment and for 7 days after they AND all of their partners are treated.
REFERENCES
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Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR. Morbidity and Mortality Weekly Report, [online] 69. Available at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a6.htm#:~:text=Based%20on%20review%20of%20recent
Centers for Disease Control and Prevention (2021). Gonococcal Infections Among Adolescents and Adults - STI Treatment Guidelines. [online] www.cdc.gov. Available at: https://www.cdc.gov/std/treatment-guidelines/gonorrhea-adults.htm
Practice update, https://www.practiceupdate.com/content/cdc-guidelines-on-sexually-transmitted-infections-treatment-2021-update/124088