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Am Fam Physician. 2007;75(11):1715

CDC Changes Treatment Guidelines for Gonorrhea

Guideline source: Centers for Disease Control and Prevention

Literature search described? No

Evidence rating system used? No

Published source: Morbidity and Mortality Weekly Report, April 13, 2007

Fluoroquinolone antibiotics are no longer recommended for treatment of gonococcal infections and associated conditions such as pelvic inflammatory disease, according to revised guidelines from the Centers for Disease Control and Prevention (CDC). Consequently, cephalosporins are the only class of drugs that is still recommended and available for the treatment of gonorrhea.

Fluoroquinolones (i.e., ciprofloxacin [Cipro], ofloxacin [Floxin], and levofloxacin [Levaquin]) have been used since 1993 for the treatment of gonorrhea because of their effectiveness, availability, and convenience as a single-dose oral therapy. However, the prevalence of fluoroquinolone resistance in Neisseria gonorrhoeae has been increasing in the United States, necessitating changes in treatment regimens. Since 1999, increasing resistance of N. gonorrhoeae to fluoroquinolones has been reported, first in Hawaii, then in California and other Western states, then among men who have sex with men, and now in other populations and regions. Data from 2005 and 2006 show that the prevalence of fluoroquinolone-resistant N. gonorrhoeae has continued to increase among heterosexual men and is present in all regions of the United States.

Because fluoroquinolones are no longer recommended for the treatment of gonorrhea, treatment options are limited. For the treatment of uncomplicated urogenital and anorectal gonorrhea, the CDC now recommends a single 125-mg intramuscular dose of ceftriaxone (Rocephin) or a single 400-mg oral dose of cefixime (Suprax). Alternative regimens include a single 400-mg oral dose of cefpodoxime (Vantin) or a 1-g dose of cefuroxime (Ceftin).

For pharyngeal gonorrhea, the CDC now recommends a single 125-mg intramuscular dose of ceftriaxone.

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