Gonococcal Arthritis Medication

  • Author: Michael P Keith, MD, FACP, FACR; Chief Editor: Herbert S Diamond, MD   more...
 
Updated: Aug 19, 2011
 

Medication Summary

The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications.

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Antibiotics

Class Summary

These agents are indicated to treat gonococcal infection. Agents effective against chlamydial infection are included because of the significant co-infection rate.

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Ceftriaxone (Rocephin)

 

Ceftriaxone is the DOC for disseminated gonococcal infection (DGI) or gonococcal arthritis, according to CDC guidelines. Bactericidal action is through inhibition of cell wall synthesis. No activity against Chlamydia.

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Cefotaxime (Claforan)

 

An alternative third-generation cephalosporin to ceftriaxone for DGI or gonococcal arthritis. Bactericidal action is through inhibition of cell wall synthesis. No activity against Chlamydia.

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Ceftizoxime (Cefizox)

 

Third-generation cephalosporin with broad-spectrum, gram-negative activity. May be used as an alternative to ceftriaxone for gonococcal arthritis or DGI. Lower efficacy against gram-positive organisms. Higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins.

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Cefixime (Suprax)

 

By binding to one or more of the penicillin-binding proteins, it arrests bacterial cell wall synthesis and inhibits bacterial growth. In 2008, Morbidity and Mortality Weekly Report reported that manufacture of this medication resumed in the United States.[14] It is the only oral cephalosporin that the CDC recommends for use in patients with DGI or gonococcal arthritis.

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Doxycycline (Vibramycin)

 

Commonly used as a cotreatment for suspected Chlamydia infection. May be used in complicated cases of gonococcal urethritis but not recommended for septic arthritis from gonococcus or a disseminated infection. Bacteriostatic by inhibiting bacterial protein synthesis.

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Azithromycin (Zithromax)

 

Alternative to doxycycline as cotreatment aimed at Chlamydia infection. Ideal for the noncompliant patient because may be given as a one-time dose. Not a cited DOC for gonococcal arthritis or DGI.

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Erythromycin base (E-mycin)

 

Alternative to doxycycline for Chlamydia infection. Medication used to cotreat Chlamydia infection in pregnancy. Not a cited DOC for treatment of gonococcal arthritis or DGI. Acts through inhibition of bacterial protein synthesis.

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Amoxicillin (Amoxil, Biomox, Trimox)

 

According to CDC guidelines, amoxicillin may be used for the treatment of chlamydia in pregnant women. Not a cited DOC for DGI or gonococcal arthritis.

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Spectinomycin (Trobicin)

 

Inhibits protein synthesis in bacterial cells. Site of action is 30S ribosomal subunit and is structurally different from related aminoglycosides. Recommended by the CDC as an option in patients intolerant of cephalosporin antibiotics[12] ; however, this medication is not currently manufactured in the United States and may not be available.[15]

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Levofloxacin (Levaquin)

 

Used to treat complicated and uncomplicated skin and skin structure infections. Fluoroquinolones should be used empirically in patients likely to develop exacerbation due to organisms resistant to other antibiotics. This is the L stereoisomer of the D/L parent compound ofloxacin, the D form being inactive. Good monotherapy with extended coverage against Pseudomonas species, as well as excellent activity against pneumococcus. Agent acts by inhibition of DNA gyrase activity. Oral form has a reported bioavailability of 99%. New CDC guidelines no longer recommend fluoroquinolones because of resistance. May be used as alternative for DGI in patients unable to take cephalosporins if culture shows sensitivity to fluoroquinolones.

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Ciprofloxacin (Cipro)

 

Useful for initial therapy when given intravenously and for oral therapy after initial response to intravenous therapy. Also effective against Chlamydia. Can be used to treat patients who are penicillin allergic. Do not use in pregnant or pediatric persons. New CDC guidelines no longer recommend fluoroquinolones because of resistance. May be used as alternative for DGI in patients unable to take cephalosporins if culture shows sensitivity to fluoroquinolones.

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Ofloxacin (Floxin)

 

Useful medication for initial therapy when given IV and for oral therapy after an initial response to IV therapy. Also effective against Chlamydia and can be used to treat patients who are penicillin allergic. Do not use in pregnant or pediatric population. New CDC guidelines no longer recommend fluoroquinolones because of resistance. May be used as alternative for DGI in patients unable to take cephalosporins if culture shows sensitivity to fluoroquinolones.

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Contributor Information and Disclosures
Author

Michael P Keith, MD, FACP, FACR  Chief of Rheumatology, National Naval Medical Center and Walter Reed Army Medical Center; Assistant Professor of Medicine, Uniformed Services University of the Health Sciences

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

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

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD  Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine; 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, and Phi Beta Kappa

Disclosure: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Timothy M Straight, MD, to the development and writing of this article.

References

  1. Dalla Vestra M, Rettore C, Sartore P, Velo E, Sasset L, Chiesa G, et al. Acute septic arthritis: remember gonorrhea. Rheumatol Int. Nov 2008;29(1):81-5. [Medline].

  2. Bardin T. Gonococcal arthritis. Best Pract Res Clin Rheumatol. Apr 2003;17(2):201-8. [Medline].

  3. Rice PA. Gonococcal arthritis (disseminated gonococcal infection). Infect Dis Clin North Am. Dec 2005;19(4):853-61. [Medline].

  4. Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2005 supplement, gonococcal isolate surveillance project (GISP) Annual Report 2005. Atlanta, GA. US Department of Health and Human Services, Centers for Disease Control and Prevention, January 2007. Available at http://www.cdc.gov.std.gisp2005/. Accessed May 12, 2009.

  5. World Health Organization Fact Sheet Number 110. Available at http://www.who.int/mediacentre/factsheets/fs110/en/index.html. Accessed May 12, 2009.

  6. Marker-Hermann E. Septic arthritis, osteomyelitis, gonococcal and syphilitic arthritis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 4th ed. Philadelphia, PA: Mosby Elsevier; 2008:1013-28.

  7. Davis BT, Pasternack MS. Case records of the Massachusetts General Hospital. Case 19-2007 - a 19-year-old college student with fever and joint pain. N Engl J Med. Jun 21 2007;356(25):2631-7. [Medline].

  8. Liebling MR, Arkfeld DG, Michelini GA, Nishio MJ, Eng BJ, Jin T, et al. Identification of Neisseria gonorrhoeae in synovial fluid using the polymerase chain reaction. Arthritis Rheum. May 1994;37(5):702-9. [Medline].

  9. Read P, Abbott R, Pantelidis P, Peters BS, White JA. Disseminated gonococcal infection in a homosexual man diagnosed by nucleic acid amplification testing from a skin lesion swab. Sex Transm Infect. Oct 2008;84(5):348-9. [Medline].

  10. Kimmitt PT, Kirby A, Perera N, Nicholson KG, Schober PC, Rajakumar K, et al. Identification of Neisseria gonorrhoeae as the causative agent in a case of culture-negative dermatitis-arthritis syndrome using real-time PCR. J Travel Med. Sep-Oct 2008;15(5):369-71. [Medline].

  11. Update to CDC's Sexually Transmitted Diseases Treatment Guidelines 2006: Fluoroquinolones no longer recommended for treatment of gonococcal infections. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a3.htm. Accessed May 1, 2009.

  12. [Guideline] Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. MMWR. 2006;55(No. RR-11):42-49.

  13. [Guideline] Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR. RR-12;59:49-55. [Medline].

  14. MMWR. Availability of Cefixime 400 mg tablets---United States, April 2008. Available at http://www.cdc.gov.mmwr/preview/mmwrhtml/mm5716a5.htm. Accessed May 1, 2009.

  15. Centers for Disease Control and Prevention. Notice to readers: discontinuation of spectinomycin. MMWR. 2006;55:370.

 
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