Empiric Therapy Regimens
Empiric therapeutic regimens for urethritis are outlined below, including those for the following [2, 4, 5, 6] :
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Gonococcal and nongonococcal urethritis
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Recurrent and persistent urethritis
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Partners of patients with urethritis
If clinically-based diagnostic tools (eg, Gram-stain microscopy) are not available, treat patients with drug regimens effective against gonorrhea and Chlamydia, as follows:
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Azithromycin 1 g PO in a single dose or doxycycline 100 mg PO BID for 7d (contraindicated during pregnancy) plus
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Ceftriaxone 250 mg IM in a single dose (strongly preferred) or cefixime 400 mg PO in a single dose (plus test-of-cure in 1 week)
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Fluoroquinolones should not be used as empiric therapy because of increasing resistance of Neisseria gonorrhoeae isolates.
Nongonococcal urethritis
First-line regimens:
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Azithromycin 1 g PO in a single dose or
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Doxycycline 100 mg PO BID for 7d (contraindicated during pregnancy)
Alternative regimens:
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Erythromycin base 500 mg PO QID for 7d or
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Erythromycin ethylsuccinate 800 mg PO QID for 7d or
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Ofloxacin 300 mg PO BID for 7d or
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Levofloxacin 500 mg PO once daily for 7d
Recurrent and persistent urethritis
Recommended regimens:
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Metronidazole 2 g PO in a single dose or
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Tinidazole 2 g PO in a single dose plus azithromycin 1 g PO in a single dose
Treatment recommendations for partners
Recommendations include the following:
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Sexual partners (within the preceding 60 d) of patients treated for nongonococcal urethritis should be referred for evaluation and treatment
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Patients with Chlamydia trachomatis should be instructed to abstain from sexual intercourse until 7 d after single-dose therapy or until completion of a 7 d regimen
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Patients with Neisseria gonorrhoeae should be instructed to abstain from sexual intercourse until 7 d after single-dose therapy
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