Pediatric Cervicitis Medication
- Author: Latha Chandran, MBBS, MD, MPH; Chief Editor: Andrea L Zuckerman, MD more...
Medication Summary
The Centers for Disease Control and Prevention (CDC) revised their treatment guidelines for sexually transmitted diseases in 2010.[6] Therapy for cervicitis depends on the etiologic agent. Ceftriaxone is the recommended drug for gonorrhea; doxycycline is recommended for chlamydial cervicitis. The dose of ceftriaxone for the treatment of gonorrhea is now 250 mg intramuscularly (as opposed to the prior recommendation of 125 mg). Other effective antibiotics for treatment of gonorrheal disease include cefixime 400 mg as a single oral dose.
Cefixime, however, has limited efficacy in the treatment of gonococcal pharyngitis and does not provide a high and sustained bactericidal level compared with ceftriaxone, the preferred treatment choice. For chlamydial infections, azithromycin 1 g orally as a single dose is an acceptable alternative to doxycycline 100 mg orally twice daily for 7 days.
Penicillins, tetracyclines or older macrolides and fluoroquinolones are no longer recommended as treatment options for gonococcal infections. Resistance among gonococci to azithromycin has recently emerged.
For patients unable to take doxycycline, erythromycin is recommended for the treatment of chlamydial infections. A single dose of azithromycin 1 g orally is also highly effective for treatment of chlamydial disease. If a patient has clinical cervicitis, both ceftriaxone and azithromycin are recommended as empirical treatment. Acyclovir may be used for primary herpes infection, but it is not curative, and recurrences are common. Metronidazole is the drug of choice for infection by Trichomonas organisms.
Antibiotics
Class Summary
Testing to determine the specific microorganism causing the infection is recommended because both chlamydial and gonococcal infections are reportable to state health departments. If diagnostic tools (eg, Gram stain, microscope) are unavailable, treat patients for both infections.
Ceftriaxone (Rocephin)
First choice for treatment for gonococcal cervicitis.
Doxycycline (Bio-Tab, Vibramycin, Doryx)
Treatment of choice for chlamydial cervicitis.
Metronidazole (Flagyl)
Synthetic antimicrobial agent active against most obligate anaerobes. Used in Trichomonas infection.
Azithromycin (Zithromax)
Macrolide antibiotic for treatment of C trachomatis infection.
Cefixime (Suprax)
Effective PO for treating gonococcal cervicitis. Arrests bacterial cell-wall synthesis and inhibits bacterial growth by binding to one or more penicillin-binding protein.
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Sexually transmitted diseases: gonorrhea, Chlamydia trachomatis, pelvic inflammatory disease and syphilis. In: Emans SJ, Laufer MR, Goldstein DP, et al, eds. Pediatric and Adolescent Gynecology. 4th ed. Philadelphia, PA: Lippincott-Raven; 1998:457-504.
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