Changes to Just One Antibiotic for Treating Gonorrhea

You’ll start to see a shift in gonorrhea treatment.

Ceftriaxone 250 mg IM plus azithromycin 1 g orally has been recommended for years…to try to slow gonorrhea resistance and cover possible chlamydia coinfection.

But ceftriaxone 250 mg may not be a high-enough dose in some cases…and azithromycin resistance continues to rise in some areas.

That’s why updated U.S. guidelines now recommend ceftriaxone ALONE for gonorrhea…at a higher dose.

Expect some prescribers to follow the new recommendations…one dose of ceftriaxone 500 mg IM for patients weighing under 150 kg…or 1 g for those 150 kg or more.

Don’t be surprised if fewer patients get empiric treatment for chlamydia. Antimicrobial stewardship is a bigger focus…and many labs report gonorrhea and chlamydia test results at the same time.

For documented chlamydia coinfection, recommend adding doxycycline 100 mg orally BID for 7 days…INSTEAD of one dose of azithromycin 1 g…for patients living in areas with increasing azithromycin resistance.

But continue to recommend azithromycin for chlamydia in pregnant patients…others who can’t take doxycycline…or if adherence is a concern.

Urge partners to be seen…ceftriaxone IM is the most effective option for gonorrhea. For partners who won’t be seen, suggest one dose of cefixime 800 mg orally…PLUS doxycycline for chlamydia if needed.

Inform patients they can anonymously notify partners about the need to be evaluated using websites such as TellYourPartner.org.

Counsel patients to abstain from sexual activity during treatment…and for 7 days after they AND all of their partners are treated.