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Gonococcal Arthritis Medication

  • Author: Rachel Robbins, MD; Chief Editor: Herbert S Diamond, MD  more...
 
Updated: Jul 13, 2015
 

Medication Summary

The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications. Disseminated gonococcal infection (DGI) or gonococcal arthritis is treated with antibiotics.

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Antibiotics

Class Summary

Dual antibiotic regimens (preferably cetriaxone plus azithromycin) are indicated for treatment of gonococcal infection.

The 2015 CDC recommendations for disseminated gonococcal infection are[14] :

Ceftriaxone 1 g IM/IV every 24 h plus a single dose of azithromycin 1 g PO

Alternative regimen - Cefotaxime 1 g IV every 8 h plus a single dose of azithromycin 1 g PO

When treating for the arthritis-dermatitis syndrome, the healthcare provider can switch to an oral agent guided by antimicrobial susceptibility testing 24-48 h after substantial clinical improvement, for a total treatment course of at least 7 days.

Ceftriaxone (Rocephin)

 

Ceftriaxone is the drug of choice for DGI or gonococcal arthritis, according to guidelines developed by the Centers for Disease Control and Prevention (CDC). It exerts its bactericidal action through inhibition of cell-wall synthesis. It has no activity against Chlamydia.

Azithromycin (Zithromax, Zmax)

 

Azithromycin inhibits bacterial growth, possibly by blocking the dissociation of peptidyl transfer ribonucleic acid (tRNA) from ribosomes, causing RNA-dependent protein synthesis to arrest. It is part of the first-line preferred dual-drug regimen for disseminated gonococcal infections plus ceftriaxone IM/IV.

Cefotaxime (Claforan)

 

Cefotaxime is a third-generation cephalosporin used as an alternative to ceftriaxone for treatment of DGI or gonococcal arthritis. It exerts its bactericidal action through inhibition of cell-wall synthesis.

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Contributor Information and Disclosures
Author

Rachel Robbins, MD Internist and Chief of Medical Residents, Walter Reed National Military Medical Center; Assistant Professor of Medicine, Uniformed Services University

Rachel Robbins, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Michael P Keith, MD, FACP, FACR Chief of Rheumatology, Walter Reed National Military Medical Center; Associate Professor of Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine

Michael P Keith, MD, FACP, FACR is a member of the following medical societies: American College of Physicians, American College of Rheumatology, Clinical Immunology Society

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

Lawrence H Brent, MD Associate Professor of Medicine, Jefferson Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center

Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, and American College of Rheumatology

Disclosure: Genentech Honoraria Speaking and teaching; Genentech Grant/research funds Other; Amgen Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Abbott Immunology Honoraria Speaking and teaching; Takeda Honoraria Speaking and teaching; UCB Speaking and teaching; Omnicare Consulting fee Consulting; Centocor Consulting fee Consulting

Timothy M Straight, MD Instructor, Department of Medicine, Uniformed Services University School of Medicine

Timothy M Straight, MD is a member of the following medical societies: American College of Physicians

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

References
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synovial joint
The lesion on this patient's heel was due to the systemic dissemination of the N. gonorrhoeae bacteria.
The foot of this patient is swollen due to gonococcal arthritis.
This patient presented with cutaneous foot lesions that were diagnosed as a disseminated gonococcal infection.
 
 
 
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