Gonococcal Infections Medication

  • Author: Brian Wong, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Aug 18, 2011
 

Medication Summary

Rapid cure of gonorrhea is critical to curtail transmission. Factors that influence therapeutic decisions include (1) antimicrobial susceptibility, (2) pharmacokinetic characteristics, (3) efficacy in complicated/uncomplicated infection, (4) differential efficacy at various anatomic sites of infection, (5) toxicity, (6) convenience of administration, and (7) cost.

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Antibiotics

Class Summary

Therapy must cover all likely pathogens in the context of this clinical setting.

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Ceftriaxone (Rocephin)

 

Drug of choice because of the attainment of high, sustained bactericidal levels in the blood. Also, there have been recent concerns regarding developing drug resistance with certain oral formulations. Negative considerations include possibly higher drug cost, discomfort because of injection, and additional expense due to injection administration. Binds to PBPs, inhibiting bacterial cell wall growth.

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Cefixime (Suprax)

 

Cephalosporin that inhibits bacterial cell wall synthesis by binding to 1 or more of the PBPs. Secondary drug of choice because drug levels are not as high, nor as sustained, a bactericidal level as that seen with the 250-mg dose of ceftriaxone. In addition, possible resistance development is another concerning trend. If ceftriaxone is not an option, it may be considered because of oral administration, single-dose treatment, and perhaps lower cost compared to parenteral medication. Available as tabs and powder for oral suspension.

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Doxycycline (Vibramycin, Bio-Tab, Doryx)

 

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

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Azithromycin

 

Binds to the 50S ribosomal subunit of susceptible microorganisms and interferes with bacterial protein synthesis.

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Contributor Information and Disclosures
Author

Brian Wong, MD  Assistant Professor of Medicine, Division of Infectious Diseases, Loma Linda University Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Larry I Lutwick, MD  Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Renuka Heddurshetti, MD  Fellow in Infectious Diseases, Department of Internal Medicine, State University of New York at Brooklyn

Renuka Heddurshetti, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Sanda Cebular, MD  Fellow, Department of Medicine, Section of Infectious Diseases, State University of New York at Brooklyn

Sanda Cebular, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Kenneth C Earhart, MD  Deputy Head, Disease Surveillance Program, United States Naval Medical Research Unit #3

Kenneth C Earhart, MD is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

John L Brusch, MD, FACP  Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

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This patient presented with gonococcal urethritis, which became systemically disseminated, leading to gonococcal conjunctivitis of the right eye. Courtesy of the CDC/Joe Miller, VD.
Gonorrhea rates, United States, 1941-2009. Centers for Disease Control and Prevention.
Gonorrhea rates by race/ethnicity, United States, 2000-2009. Centers for Disease Control and Prevention.
Gonorrhea rates by age and sex, United States, 2009. Centers for Disease Control and Prevention.
 
 
 
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