Cefixime Cure Rate for Gonorrhea

Historical Efficacy Data

The Centers for Disease Control and Prevention (CDC) recommends that cefixime 400 mg orally achieves a 97.4% cure rate for uncomplicated urogenital and anorectal gonorrhea, based on data from clinical trials that met the minimum 95% efficacy threshold for first-line therapy 1, 2
For pharyngeal gonorrhea specifically, cefixime demonstrates only 91% efficacy, which is substantially lower than urogenital sites and represents a critical limitation 2

The CDC removed cefixime from first-line recommendations in 2012 due to concerning resistance trends that mirror the pattern seen with fluoroquinolones in the 1990s, with isolates with elevated cefixime MICs increasing from 0.1% in 2006 to 1.5% in 2011 nationally 3, 4
Among men who have sex with men (MSM), elevated cefixime MICs increased from 0.2% to 3.8% between 2006 and 2011, indicating a higher prevalence of resistant strains in this population 3, 4, 5

The CDC recommends ceftriaxone 125 mg IM as first-line therapy, and cefixime 400 mg plus azithromycin 1 g orally as alternative therapy only when ceftriaxone is unavailable, with mandatory test-of-cure at 1 week 3, 6
Cefixime should never be used alone without azithromycin or doxycycline co-treatment, and should be avoided for pharyngeal infections given 91% efficacy versus >95% required for first-line therapy 2, 3, 4, 6