CDC: Stop using oral cephalosporins to treat gonorrhea
Start using combination therapy with ceftriaxone and either azithromycin or doxycycline because of increasing resistance to oral cephalosporins.
- It is essential that culture capacity for N. gonorrhoeae be maintained to monitor antimicrobial resistance trends and determine susceptibility to guide treatment following treatment failure. To help control gonorrhea in the United States, health-care providers must maintain the ability to collect specimens for culture and be knowledgeable of laboratories to which they can send specimens for culture. Health-care systems and health departments must support access to culture, and laboratories must maintain culture capacity or develop partnerships with laboratories that can perform culture.
Treatment failure
Clinicians treating a patient with persistent infection after treatment with the recommended therapy should culture relevant clinical specimens and perform antimicrobial susceptibility testing of N. gonorrhoeae isolates. Phenotypic antimicrobial susceptibility testing should be performed using disk diffusion, Etest (BioMerieux), or agar dilution. Data are limited on the use of NAAT-based antimicrobial susceptibility testing for genetic mutations.
Patients who experience treatment failure after treatment with alternative regimens should be treated with ceftriaxone 250 mg as a single intramuscular dose and azithromycin 2 g orally as a single dose and should receive infectious disease consultation.
Consult an infectious disease specialist, an STD/HIV Prevention Training Center, or the CDC for treatment advice, and report the case to the CDC through a health department within 24 hours of diagnosis. Conduct test-of-cure 7 days after re-treatment.
Sexual partners
Clinicians should make every effort to ensure that the patient’s sex partners from the preceding 60 days are evaluated promptly and treated as indicated.
“Treatment of patients with gonorrhea with the most effective therapy will limit the transmission of the disease, prevent complications, and slow the emergence of resistance,” wrote CDC reporters. “However, resistance to cephalosporins, including ceftriaxone, is expected to emerge. Reinvestment in gonorrhea prevention and control is warranted. New treatment options for gonorrhea are urgently needed.”1
For the full MMWR article on new gonorrhea treatment guidelines, visit https://1.usa.gov/OxjuaQ
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