Therefore, practitioners should be aware of the potential interactions with oral calcium in young infants receiving intravenous ceftriaxone, and the potential side effects of intravenous or oral calcium in infants receiving intramuscular ceftriaxone. When ceftriaxone cannot be used to treat urogenital or rectal gonorrhea, there are two options: A patient with gonorrhea treated with an alternative regimen should return 1 week after treatment for a test-of-cure at the infected anatomic site. Clinical data are not available that support the use of an increased dose. However, the evidence of emerging cephalosporin resistance is following a similar pattern to that seen in 2007, when gonorrhea became fluoroquinolone-resistant.1,5, “The challenge is that there is not a well-studied second antibiotic we can turn to even when cephalosporin resistance does emerge,” said Robert D. Kirkcaldy, a medical epidemiologist at the CDC.

a) Antibiotics with excellent oral bioavailability Drug Oral bioavailability IV dose Oral dose Metronidazole 100 % 500 mg bd 400 mg bd Ciprofloxacin ~ 70 % 200 - 400 mg bd 500 mg bd Fluconazole > 90 % 200 – 400 mg d 200 – 400 mg d Clindamycin 90 % 300 - 600 mg tds 300 - 600 mg tds

Update to CDC’s Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral cephalosporins no longer a recommended treatment for gonococcal infections. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Cefdinir: An oral alternative to parenteral cephems. Only one gonorrhea drug remains for routine cases, CDC says. If the NAAT is positive, make every effort to perform a confirmatory culture. 5. It takes time for inflammation to heal and reverse. Cost savings are possible if oral cephems of equivalent efficacy can be substituted for parenteral cephems. Saving You Time. Updated July 8, 2011. 2. Ceftriaxone 2g IV q24h Ciprofloxacin 500 PO BID Levofloxacin 500-750mg* PO daily nd2 line oral alternatives: Case by case basis. http://womenshealth.gov/publications/our-publications/fact-sheet/gonorrhea.cfm#h. Activities were determined by National Committee for Clinical Laboratory Standards microbroth dilution methodology using an inoculum of approximately 5 × 105 CFU/mL. Some medications are potent only in certain forms, for example Insulin is only delivered in a needle. 5. None for GC: It sounds like you're asking about treatment of gonorrhea. By continuing you agree to the use of cookies. The information provided is for educational purposes only. 2010 sexually transmitted diseases surveillance: Gonorrhea. NY Times Health Science. MMWR. 'Gram-negative: 'Third-generation cephalosporins have a broad spectrum of activity and further increased activity against gram-negative organisms. “What we’ve been noticing is really since 2009 and 2010, it’s taking higher concentrations of antibiotic to kill the bacteria. Accessed August 13, 2012. Risk of fatal calcium-ceftriaxone precipitant formation in lungs and kidneys of term and preterm neonates; 28 days: Do not give any calcium-containing IV drugs or products within 48 hours of ceftriaxone (within 5 days if neonate is ; 10 days, per Health Canada) Should I ask chage to ceftriaxone or cefotetan? … To treat uncomplicated urogenital, anorectal, and pharyngeal gonorrhea, the CDC now recommends combination therapy with a single intramuscular dose of ceftriaxone 250 mg plus either a single dose of azithromycin 1 g orally or doxycycline 100 mg orally twice a day for 7 days. verted to oral therapy. This could mean resistance to the last antibiotic we have for gonorrhea could be on the horizon.”5, The CDC’s updated guidelines include treatment plans for uncomplicated disease; specific alternatives if ceftriaxone cannot be used; test-of-cure procedures; treatment failure strategies; and recommendations for sexual partners.1. Alternatives. Accessed August 13, 2012. CDC reporters del Rio and colleagues write in MMWR:1.

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