Alternative Treatment Options for Gonorrhea and Chlamydia
Introduction to Alternative Treatments
- For patients with ceftriaxone allergy or contraindications, azithromycin 2g orally in a single dose is the recommended alternative treatment for gonorrhea, with concurrent treatment for chlamydia using appropriate alternatives 1
Alternative Treatment Regimens for Gonorrhea
- Spectinomycin 2g IM in a single dose is an effective alternative for uncomplicated urogenital and anorectal gonococcal infections, with cure rates of 98.2% 2
- Single-dose cephalosporin regimens that can be used include Ceftizoxime 500mg IM 2
- Cefoxitin 2g IM with probenecid 1g orally can be used as an alternative 3
- Cefotaxime 500mg IM is another option 2, 3
Quinolone Options
- Quinolones should only be used if susceptibility has been confirmed due to widespread resistance 4
- Options include Ciprofloxacin 500mg orally in a single dose 2
- Ofloxacin 400mg orally in a single dose can be used 3
- Levofloxacin 250mg orally in a single dose is another option 2, 3
Treatment for Chlamydia
- Azithromycin 1g orally in a single dose is a first-line option 5
- Doxycycline 100mg orally twice daily for 7 days is another first-line option 5
- Erythromycin base or ethylsuccinate 50mg/kg/day orally divided into four doses daily for 14 days can be used as an alternative, particularly for children or when other options are contraindicated 6
Special Considerations
- A test of cure should be performed 1 week after treatment with alternative regimens 1, 7
- Culture is the preferred method for test of cure as it allows for antimicrobial susceptibility testing 7
- Pharyngeal gonorrhea is more difficult to eradicate than urogenital or anorectal infections 4
- Spectinomycin has poor efficacy (only 52%) against pharyngeal gonorrhea 4
Partner Management
- All sex partners from the preceding 60 days should be evaluated and treated 2, 7
- Patients should avoid sexual intercourse until therapy is completed and both they and their partners are asymptomatic 2, 7