Recommended Treatment for Gonococcal Infections: Adapted from the 2015 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 Azithromycin (1 g PO, single dose) |
| 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 plus Azithromycin (1 g PO, single dose) |
| Epididymitis | Ceftriaxone (250 mg IM once) followed by doxycycline (100 mg PO bid for 10 days) |
| Pelvic inflammatory disease | See text on specific syndrome |
| 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 | See text for specific recommendationsj |
a True 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.
b Ceftriaxone and azithromycin are the only agents recommended for treatment of pharyngeal infection.
c See text for follow-up of persons with infection who are treated with alternative regimens.
d Spectinomycin, cefotetan, and cefoxitin, which are alternative agents, currently are unavailable or in short supply in the United States.
e Spectinomycin may be ineffective for the treatment of pharyngeal gonorrhea.
f Plus lavage of the infected eye with saline solution (once).
g Prophylactic regimens are discussed in the text.
h Hospitalization 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.
i All initial regimens should also include azithromycin (1 g PO, single dose) and 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) 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.
j Hospitalization is indicated to exclude suspected meningitis or endocarditis.