Recommended Treatment for Gonococcal Infections: Adapted from the 2010 Guidelines of the Centers for Disease Control and Prevention
| Diagnosis | Treatment of Choicea |
|---|---|
| Uncomplicated gonococcal infection of the cervix, urethra, pharynxb, or rectum | |
| First-line regimen | Ceftriaxone (250 mg IM, 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 regimensc | Cefixime (400 mg PO, single dose) |
| or | |
| Ceftizoxime (500 mg IM, single dose) | |
| or | |
| Cefotaxime (500 mg IM, single dose) | |
| or | |
| Spectinomycin (2 g IM, single dose)d, e | |
| or | |
| Cefotetan (1 g IM, single dose) plus probenecid (1 g PO, single dose)d | |
| or | |
| Cefoxitin (2 g IM, single dose) plus probenecid (1 g PO, single dose)d | |
| Epididymitis | Ceftriaxone (250 mg IM once) followed by doxycycline (100 mg PO bid for 10 days) is effective for epididymitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. |
| Pelvic inflammatory disease | See Chap. 163. Osteoarthritis in HPIM-19 |
| Outpatient | Ceftriaxone (250 mg IM once) plus Doxycycline (100 mg PO bid for 14 days) plus Metronidazole (500 mg PO bid for 14 days) |
| Inpatient | Cefotetan (2 g IV q12h) or cefoxitin (2 g IV q6h) plus doxycycline (100 mg IV/PO q12h) or Clindamycin (900 mg IV q8h) plus gentamicin (loading dose of 2.0 mg/kg IV/IM followed by 1.5 mg/kg q8h) |
| Gonococcal conjunctivitis in an adult | Ceftriaxone (1 g IM, single dose)f |
| Ophthalmia neonatorumg | Ceftriaxone (25-50 mg/kg IV, single dose, not to exceed 125 mg) |
| Disseminated gonococcal infectionh | |
| Initial therapyi | |
| Pt tolerant of β-lactam drugs | Ceftriaxone (1 g IM or IV q24h; recommended) or Cefotaxime (1 g IV q8h) or Ceftizoxime (1 g IV q8h) |
| Pts allergic to β-lactam drugs | Spectinomycin (2 g IM q12h)d |
| Continuation therapyi | Cefixime (400 mg PO bid) |
| Meningitis or endocarditis | Ceftriaxone (1-2 g IV bid) for 10-14 days (meningitis) or ≥4 weeks (endocarditis)j |
aTrue failure of treatment with a recommended regimen is rare and should prompt an evaluation for reinfection, infection with a drug-resistant strain, or an alternative diagnosis.
bCeftriaxone is the only agent recommended for treatment of pharyngeal infection.
cPersons given an alternative regimen should return for a test of cure targeting the infected anatomic site, with a culture strongly preferred over a NAAT. All positive cultures for test of cure should undergo antimicrobial susceptibility testing.
dSpectinomycin, cefotetan, and cefoxitin, which are alternative agents, currently are unavailable or in short supply in the United States.
eSpectinomycin may be ineffective for the treatment of pharyngeal gonorrhea.
fPlus lavage of the infected eye with saline solution (once).
gOcular neonatal instillation of a prophylactic agent (e.g., 1% silver nitrate eye drops or ophthalmic preparations containing erythromycin or tetracycline) prevents ophthalmia neonatorum but is not effective for its treatment, which requires systemic antibiotics.
hHospitalization is indicated if the diagnosis is uncertain, if the pt has frank arthritis with an effusion, or if the pt cannot be relied on to adhere to treatment.
iAll initial regimens should be continued for 24-48 h after clinical improvement begins, at which time the switch may be made to an oral agent (e.g., cefixime or a quinolone) if antimicrobial susceptibility can be documented by culture of the causative organism. If no organism is isolated and the diagnosis is secure, then treatment with ceftriaxone should be continued for at least 1 week. Treatment for chlamydial infection (as above) should be given if this infection has not been ruled out.
jHospitalization is indicated to exclude suspected meningitis or endocarditis.