Gonococcus Medication

Treatment of N gonorrhoeae and Chlamydia trachomatis is generally indicated for lower genitourinary infections, PID, epididymitis, proctitis, pharyngitis, conjunctivitis, and DGI. Antibiotics for coverage of gonococcal infection are listed below. Additional regimens are available but show no clear advantage over the antibiotics. Chlamydial infection or suspected infection is covered by azithromycin or doxycycline. Erythromycin and amoxicillin are less effective but should be substituted in pregnant women and children. Treatment of PID may require coverage for additional organisms, including enteric anaerobes.

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Ceftriaxone (Rocephin)

Bactericidal activity results from inhibition of cell wall synthesis. Has high degree of stability in presence of beta-lactamases, both penicillinases and cephalosporinases, of gram-negative and gram-positive bacteria.

Azithromycin (Zithromax)

Treats mild-to-moderate microbial infections.

Doxycycline (Bio-Tab, Doryx, Vibramycin)

Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

Erythromycin (EES, E-Mycin, Ery-Tab)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections.

In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be taken q12h. For more severe infections, double the dose.

Amoxicillin (Amoxil, Polymox, Trimox)

Interferes with synthesis of cell wall mucopeptides during active multiplication resulting in bactericidal activity against susceptible bacteria.

Spectinomycin (Trobicin)

Used to treat most types of gonorrhea. Given by injection into a muscle. Sometimes given with other medicines for gonorrhea and related infections.

May be used in patients who are allergic to penicillins, cephalosporins, or probenecid (eg, Benemid). This medicine also is used to treat recent sexual partners of patients who have gonorrhea.

Second-line treatment of gonorrhea and gonococcal urethritis, cervicitis, or proctitis in patients who are infected with penicillin-resistant strains of N gonorrhoeae. Treatment of gonorrhea and gonococcal urethritis, cervicitis, or proctitis in patients allergic to beta-lactam anti-infectives (including ceftriaxone).

Inhibits bacterial protein synthesis at the level of the 30S ribosome. Bactericidal action against susceptible organisms. Most notable for activity against N gonorrhoeae, including penicillinase-producing strains (PPNG). Not active against Treponema pallidum or C trachomatis.

Tetracycline (Sumycin)

Treats gram-positive and gram-negative organisms, as well as mycoplasmal, chlamydial, and rickettsial infections. Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s).

Cefixime (Suprax)

Third-generation oral cephalosporin with broad activity against gram-negative bacteria. By binding to one or more of the penicillin-binding proteins, it arrests bacterial cell wall synthesis and inhibits bacterial growth.

Note: After a period of unavailability, oral cefixime is again FDA-approved in tab and susp forms. However, at the time of writing, tabs remain unavailable in the United States. Wyeth Pharmaceuticals (Collegeville, Pa) discontinued manufacturing cefixime (Suprax) in the United States. In October 2002, the company ceased marketing cefixime tablets (200 mg and 400 mg) because of depletion of company inventory; the company's patent for cefixime expired on November 10, 2002.