Azithromycin Treatment for Gonorrhea

Efficacy and Safety

The Centers for Disease Control and Prevention recommends against using azithromycin 1 g monotherapy for gonorrhea, as it has only 93% efficacy 1, 2
Azithromycin 1 g monotherapy has limited efficacy for gonorrhea treatment, with a cure rate of 93%, making it inadequate as a standalone treatment 1, 2
Splitting the 2 g dose of azithromycin would likely reduce peak serum concentrations and tissue penetration, potentially compromising efficacy further 3

The American College of Physicians and the Centers for Disease Control and Prevention recommend a single 2 g oral dose of azithromycin (not split) for patients with severe cephalosporin allergy 4, 5, 1
A mandatory test-of-cure at 1 week is required when using azithromycin 2 g as monotherapy 4, 5, 3
The Centers for Disease Control and Prevention recommends against using azithromycin 1 g alone for gonorrhea, as it cures only 93% of infections 1, 2

The Centers for Disease Control and Prevention recommends culture or NAAT at 1 week post-treatment when azithromycin 2 g is used as monotherapy 4, 5, 3
Culture is preferred as it allows antimicrobial susceptibility testing 3
Treatment failures should be reported to public health within 24 hours and infectious disease specialists should be consulted 1, 2