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Posted By: Lawrence Herman, DMSc, MPA, PA-C
January 15, 2021
We have all been so focused on COVID-19 that many of us missed the updated guidelines on the treatment of two sexually transmitted infections (STIs): Neisseria gonorrhoeae and Chlamydia trachomatis. STIs caused by gonococcal infections have increased 63% since 2014. Despite the fact that in 2010, the Centers for Disease Control and Prevention (CDC) recommended treatment of uncomplicated gonococcal infections with a higher dose of ceftriaxone (250 mg intramuscularly [IM]) plus a single 1-g dose of azithromycin, resistance continues to emerge.
Based upon a review of the evidence, the CDC has now revised their guidelines for the treatment of uncomplicated gonococcal infection. They now recommend a single injection of ceftriaxone 500 mg IM plus doxycycline 100 mg by mouth, twice daily for seven days, when a chlamydial infection has not been excluded. For those weighing more than 300 pounds, the ceftriaxone dose should be doubled, to 1 g IM.
Alternative drugs for those with cephalosporin allergies include a single dose of gentamycin 240 mg IM plus a single dose of azithromycin 2 g orally.
Much of what drove the CDC to make these changes stems from a very interesting 2019 report on antimicrobial resistance threats in the United States, along with the need for antibiotic stewardship. The report detailed how data continue to support the alarming impact of inappropriate antibiotic use in adults and children and the impact of that use on the gut microbiome and pathogenic organisms. It is a particularly fascinating read that warrants review by all of us before we write another prescription for an antibiotic.
- Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2019. www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf. Accessed January 14, 2021.
- St Cyr S, et al. Update to CDC's treatment guidelines for gonococcal infection, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1911–1916.