TAILIEUCHUNG - Chapter 137. Gonococcal Infections (Part 9)

Single-dose regimens of the third-generation cephalosporins ceftriaxone (given IM) and cefixime (given orally) are the mainstays of therapy for uncomplicated gonococcal infection of the urethra, cervix, rectum, or pharynx. Quinolone-containing regimens are no longer recommended in the United States as first-line treatment because of widespread resistance to these agents. Because co-infection with C. trachomatis occurs frequently, initial treatment regimens must also incorporate an agent (., azithromycin or doxycycline) that is effective against chlamydial infection. Pregnant women with gonorrhea, who should not take doxycycline, should receive concurrent treatment with a macrolide antibiotic for possible chlamydial infection. . | Chapter 137. Gonococcal Infections Part 9 Single-dose regimens of the third-generation cephalosporins ceftriaxone given IM and cefixime given orally are the mainstays of therapy for uncomplicated gonococcal infection of the urethra cervix rectum or pharynx. Quinolone-containing regimens are no longer recommended in the United States as first-line treatment because of widespread resistance to these agents. Because co-infection with C. trachomatis occurs frequently initial treatment regimens must also incorporate an agent . azithromycin or doxycycline that is effective against chlamydial infection. Pregnant women with gonorrhea who should not take doxycycline should receive concurrent treatment with a macrolide antibiotic for possible chlamydial infection. A single 1-g dose of azithromycin which is effective therapy for uncomplicated chlamydial infections results in an unacceptably low cure rate 93 for gonococcal infections and should not be used alone. Spectinomycin has been an alternative regimen for the treatment of uncomplicated gonococcal infections in penicillin-allergic persons. However spectinomycin is not available in the United States at this time. A single 2-g dose of azithromycin is effective against sensitive strains but this drug is expensive causes gastrointestinal distress and is not recommended for routine or first-line treatment of gonorrhea. Persons with uncomplicated infections who receive a recommended regimen do not need a test of cure. Cultures for N. gonorrhoeae should be performed if symptoms persist after therapy with an established regimen and any gonococci isolated should be tested for antimicrobial susceptibility. Symptomatic gonococcal pharyngitis is more difficult to eradicate than genital infection. Persons who cannot tolerate cephalosporins and those in whom quinolones are contraindicated may be treated with spectinomycin if it is available but this agent results in a cure rate of 52 . Persons given spectinomycin should have a .

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