Treatment for Gonorrhea in Patients Allergic to Ceftriaxone

Primary Alternative Treatment Options

The Centers for Disease Control and Prevention recommends azithromycin 2 g orally in a single dose as an alternative treatment for gonorrhea in patients with severe cephalosporin allergy, with a test-of-cure performed 1 week after treatment 1
A test-of-cure should be conducted 1 week after treatment with this alternative regimen to ensure eradication of infection, as recommended by the Centers for Disease Control and Prevention 1
Because data are limited regarding alternative regimens for treating gonorrhea among persons with severe cephalosporin allergy, providers treating such patients should consult infectious disease specialists, as suggested by the American Academy of Ophthalmology 3

The test-of-cure for alternative regimens should ideally be performed with culture or with a NAAT if culture is not readily available, as recommended by the Centers for Disease Control and Prevention 1

If using azithromycin as an alternative treatment, a test-of-cure should be performed 1 week after treatment, as recommended by the Centers for Disease Control and Prevention 1
Culture is the preferred method for test-of-cure as it allows for antimicrobial susceptibility testing, according to the Centers for Disease Control and Prevention 4

For suspected treatment failures, obtain specimen for culture and antimicrobial susceptibility testing, as recommended by the Centers for Disease Control and Prevention 4
Report the case to local public health officials within 24 hours, as required by the Centers for Disease Control and Prevention 1
Consult an infectious disease specialist for guidance on alternative treatment options, as recommended by the Centers for Disease Control and Prevention 1

All sex partners from the preceding 60 days should be evaluated and treated, as recommended by the Centers for Disease Control and Prevention 4
Patients should avoid sexual intercourse until therapy is completed and both they and their partners are asymptomatic, according to the Centers for Disease Control and Prevention 2
If partners' treatment cannot be ensured, expedited partner therapy should be considered, as recommended by the Centers for Disease Control and Prevention 1

Due to high rates of co-infection, patients treated for gonococcal infection should also be treated routinely with a regimen effective against uncomplicated genital Chlamydia trachomatis infection, as recommended by the American Academy of Ophthalmology 3
Pregnant women should not be treated with doxycycline, quinolones, or tetracyclines; either erythromycin or amoxicillin is recommended for treatment of chlamydia during pregnancy, according to the American Academy of Ophthalmology 3