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Am Fam Physician. 2013;87(3):163

Treatment recommendations updated to be consistent with new CDC guidance. The article “Diagnosis and Management of Gonococcal Infections” (November 15, 2012, p. 931) noted that first-line antibiotic therapy for uncomplicated gonococcal infections includes intramuscular ceftriaxone (Rocephin) and either oral azithromycin (Zithromax) or doxycycline to address the likelihood of coinfection with Chlamydia trachomatis. However, the Centers for Disease Control and Prevention (CDC) recommends that azithromycin or doxycycline be administered for cotreatment of gonococcal infections, regardless of potential coinfection with chlamydia, to improve treatment effectiveness and potentially delay the development of cephalosporin resistance. Thus, there are now two reasons for combination therapy (increased effectiveness against Neisseria gonorrhoeae, and possible coinfection with chlamydia). The new CDC recommendation for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea is combination therapy with a single intramuscular dose of ceftriaxone, 250 mg, plus either a single dose of azithromycin, 1 g orally, or doxycycline, 100 mg orally twice daily for seven days. Because of increasing resistance, oral cefixime (Suprax) is no longer recommended as a first-line regimen for treatment of gonococcal infections. The relevant text in the abstract (p. 931), in the SORT table (p. 932), and under the treatment header (p. 934) in the online version of this article has been revised to be consistent with the CDC's new guidance.

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