Chapter 137. Gonococcal Infections (Part 8) Gonococcal Infections: Treatment Treatment failure can lead to continued transmission and the emergence of antibiotic resistance. The importance of adequate treatment with a regimen that the patient will adhere to cannot be overemphasized. Thus highly effective single-dose regimens have been developed for uncomplicated gonococcal infections. The updated 2006 treatment guidelines for gonococcal infections from the Centers for Disease Control and Prevention are summarized in Table 137-1; the recommendations for uncomplicated gonorrhea apply to HIV-infected as well as HIV-uninfected patients. Table 137- 1 Recommended Treatment for Gonococcal Infections: 2006 Guidelines of the Centers for Disease Control and Prevention (Updated in 2007) Diagnosis Treatment of Choice Uncomplicated gonococcal infection of the cervix, urethra, pharynx, or rectum a First-line regimens Ceftriaxone (125 mg IM, single dose) or Cefixime (400 mg PO, single dose) plus Treatment for Chlamydia if chlamydial infection is not ruled out: Azithromycin (1 g PO, single dose) or Doxycycline (100 mg PO bid for 7 days) Alternative regimens Ceftizoxime (500 mg IM, single dose) or Cefotaxime (500 mg IM, single dose) or Spectinomycin (2 g IM, single dose) b,c or Cefotetan (1 g IM, single dose) plus probenecid (1 g PO, single dose) b or Cefoxitin (2 g IM, single dose) plus probenecid (1 g PO, single dose) b Epididymitis See Chap. 124 Pelvic inflammatory disease See Chap. 124 Gonococcal conjunctivitis in an adult Ceftriaxone (1 g IM, single dose) d Ophthalmia neonatorum e Ceftriaxone (25– 50 mg/kg IV, single dose, not to exceed 125 mg) Disseminated gonococcal infection f Initial therapy g Patient tolerant of β- lactam Ceftriaxone ( 1 g IM or IV q24h; drugs recommended) or Cefotaxime (1 g IV q8h) or Ceftizoxime (1 g IV q8h) Patients allergic to β- lactam drugs Spectinomycin (2 g IM q12h) c Continuation therapy Cefixime (400 mg PO bid) Meningitis or endocarditis See text h a True f ailure of treatment with a recommended regimen is rare and should prompt an evaluation for reinfection or consideration of an alternative diagnosis. b Spectinomycin, cefotetan, and cefoxitin, which are alternative agents, currently are unavailable or in short supply in the United States. c Spectinomycin may be ineffective for the treatment of pharyngeal gonorrhea. d Plus lavage of the infected eye with saline solution (once). e Prophylactic regimens are discussed in the text. f Hospitalization is indicated if th e diagnosis is uncertain, if the patient has frank arthritis with an effusion, or if the patient cannot be relied on to adhere to treatment. g All initial regimens should be continued for 24– 48 h after clinical improvement begins, at which time therapy may be switched to one of the continuation regimens to complete a full week of antimicrobial treatment. Treatment for chlamydial infection (as above) should be given if this infection has not been ruled out. h Hospitalization is indicated to exclude suspected meningitis or endocarditis. . Chapter 137. Gonococcal Infections (Part 8) Gonococcal Infections: Treatment Treatment failure can lead to continued transmission. uncomplicated gonococcal infections. The updated 2006 treatment guidelines for gonococcal infections from the Centers for Disease Control and Prevention are summarized in Table 137- 1; the recommendations. gonorrhea apply to HIV-infected as well as HIV-uninfected patients. Table 137- 1 Recommended Treatment for Gonococcal Infections: 2006 Guidelines of the Centers for Disease Control and Prevention