Clinical Manual for Management of the HIV-Infected ... - myCME.com
Clinical Manual for Management of the HIV-Infected ... - myCME.com
Clinical Manual for Management of the HIV-Infected ... - myCME.com
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Treatment <strong>of</strong> Gonorrhea<br />
Treatment options include <strong>the</strong> following. (See <strong>the</strong> full<br />
CDC STD treatment guidelines, referenced below.)<br />
Re<strong>com</strong>mended regimens<br />
♦ Ceftriaxone 125 mg or 250 mg intramuscular<br />
(IM) injection in a single dose (some providers<br />
re<strong>com</strong>mend 250 mg because <strong>of</strong> slightly higher cure<br />
rates)<br />
♦<br />
Cefixime 400 mg orally in a single dose (tablet<br />
<strong>for</strong>mulation not currently available in <strong>the</strong> United<br />
States)<br />
Alternative regimens<br />
♦ Spectinomycin 2 g IM injection in a single dose (<strong>for</strong><br />
urogenital or anorectal GC; not sufficiently effective<br />
to treat pharyngeal GC)<br />
♦<br />
♦<br />
♦<br />
♦<br />
♦<br />
Cefpodoxime 400 mg orally in a single dose<br />
(insufficient data to be re<strong>com</strong>mended by <strong>the</strong> CDC)<br />
Cipr<strong>of</strong>loxacin 500 mg orally in a single dose (see<br />
“Note” below)<br />
Ofloxacin 400 mg orally in a single dose (see “Note”<br />
below)<br />
Lev<strong>of</strong>loxacin 250 mg orally in a single dose (see<br />
“Note” below)<br />
Azithromycin 2 g orally in a single dose (not<br />
re<strong>com</strong>mended by <strong>the</strong> CDC; high rate <strong>of</strong><br />
gastrointestinal intolerance)<br />
Note: Fluoroquinolones are not re<strong>com</strong>mended <strong>for</strong><br />
treatment <strong>of</strong> gonococcal infection in MSM or in any<br />
patient who acquired GC infection in Cali<strong>for</strong>nia,<br />
Hawaii, Massachusetts, New York City, or outside<br />
<strong>the</strong> United States, because <strong>of</strong> <strong>the</strong> high prevalence <strong>of</strong><br />
fluoroquinolone resistance.<br />
Treatment <strong>of</strong> Chlamydia<br />
(See <strong>the</strong> full CDC STD treatment guidelines,<br />
referenced below.)<br />
Re<strong>com</strong>mended regimens<br />
♦ Azithromycin 1 g orally in a single dose<br />
♦<br />
Doxycycline 100 mg orally twice daily <strong>for</strong> 7 days<br />
Alternative regimens<br />
♦ Erythromycin base 500 mg orally 4 times daily <strong>for</strong> 7<br />
days<br />
♦<br />
Erythromycin ethylsuccinate 800 mg orally 4 times<br />
daily <strong>for</strong> 7 days<br />
♦<br />
♦<br />
Section 6—Disease-Specific Treatment | 6–35<br />
Ofloxacin 300 mg orally twice daily <strong>for</strong> 7 days (see<br />
note above)<br />
Lev<strong>of</strong>loxacin 500 mg orally once daily <strong>for</strong> 7 days (see<br />
note above)<br />
Treatment <strong>of</strong> LGV<br />
Re<strong>com</strong>mended regimens<br />
♦ Doxycycline 100 mg orally twice daily <strong>for</strong> 21 days<br />
Alternative regimens<br />
♦ Erythromycin base 500 mg orally 4 times daily <strong>for</strong><br />
21 days<br />
♦<br />
Azithromycin 1 g orally once a week <strong>for</strong> 3 weeks<br />
(limited data)<br />
For recent sex partners (within 30 days <strong>of</strong> <strong>the</strong> onset <strong>of</strong><br />
symptoms), treat with azithromycin 1 g orally in a single<br />
dose or doxycycline 100 mg orally twice daily <strong>for</strong> 7 days.<br />
Treatment during Pregnancy<br />
Fluoroquinolones and tetracyclines should be avoided<br />
during pregnancy. For <strong>the</strong> treatment <strong>of</strong> GC in pregnant<br />
women, <strong>the</strong> CDC advises using ei<strong>the</strong>r a re<strong>com</strong>mended<br />
cephalosporin or spectinomycin. For <strong>the</strong> treatment <strong>of</strong><br />
CT in pregnant women, see <strong>the</strong> following.<br />
Re<strong>com</strong>mended CT regimens<br />
♦ Erythromycin base 500 mg orally 4 times daily <strong>for</strong> 7<br />
days<br />
♦<br />
Amoxicillin 500 mg orally 3 times daily <strong>for</strong> 7 days<br />
Alternative CT regimens<br />
♦ Erythromycin base 250 mg orally 4 times daily <strong>for</strong><br />
14 days<br />
♦<br />
♦<br />
♦<br />
Erythromycin ethylsuccinate 800 mg orally 4 times<br />
daily <strong>for</strong> 7 days<br />
Erythromycin ethylsuccinate 400 mg orally 4 times<br />
daily <strong>for</strong> 14 days<br />
Azithromycin 1 g orally in a single dose<br />
Follow-up<br />
♦ Evaluate sex partners and treat <strong>the</strong>m if <strong>the</strong>y had<br />
sexual contact with <strong>the</strong> patient during <strong>the</strong> 60 days<br />
preceding <strong>the</strong> patient's onset <strong>of</strong> symptoms.<br />
♦<br />
♦<br />
Most recurrent infections <strong>com</strong>e from sex partners<br />
who were not treated.<br />
If symptoms persist, evaluate <strong>for</strong> <strong>the</strong> possibility <strong>of</strong><br />
reinfection, treatment failure, or a different cause <strong>of</strong><br />
symptoms. If treatment failure is suspected, per<strong>for</strong>m<br />
culture and antimicrobial sensitivity testing.
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