A 19 y/o old AD Marine presents to your clinic after a brief leave to the Caribbean presenting with a purulent, white penile discharge and significant dysuria. A quick in-office test confirms urethral gonorrhea. The medical student working with you reminds you to treat for Chlamydia, a common co-infection with gonorrhea. He recommends a single 1 gram dose of azithromycin to treat both the GC AND Chlamydia.

Do you concur and write the prescription or not? Why or why not?

A good thought but probably not.

    Azithromycin 1gm po as a single dose is an excellent choice for the treatment of Chlamydia IN COMBINATION with an agent specifically for the gonorrhea (GC). The one gram azithromycin dose is NOT sufficiently effective to treat the GC. When the dose is accelerated to a 2 gram single oral dose, the efficacy is improved but price and often intolerable GI side effects preclude it's use (Sanfords 2002, CDC STD Guidelines 2002, MMWR 2002;51:1-80).

    Options for ORAL treatment of GC (cervical, rectal, rectal) include:

-    cefixime 400mg po x 1 (no longer manufactured)
-    ciprofloxacin 500mg po x 1
-    ofloxacin 400mg po x 1
-    levofloxacin 250mg po x 1
        ( Other quinolones are effective but offer no advantage over those listed above)

        ** CAUTION ** - Fluoroquinolones (FQ) should NOT be used as treatment if the GC is acquired in Asia, Pacific Islands (incl Hawaii) or California due to high prevalence of FQ-resistant GC.

        - All the above should include treatment for Chlamydia such as azithromycin 1gm po x1 or doxycycline 100mg po BID for 7 days.

        Injectable options to treat GC include ceftriaxone 125mg IM (probably the gold standard), spectinomycin 2gm IM (for patients who cannot tolerate PCN, cephalosporins, or FQ).

        Patients should be checked for other sexually transmitted diseases to include but not limited to HIV, syphilis, etc.
 

This Pearl is meant for academic and educational purposes only. This Pearl is meant to raise important points regarding the safe and cost-effective pharmacotherapy of patients. It is not meant to be the definitive reference for the treatment or prophylaxis of various diseases. Although every effort is taken to ensure this Pearl is correct and factual, errors may occur. The Pharmacoeconomic Center assumes no liability for incorrect information or harm that may occur from the use of the information included in this Pearl.