Azithromycin is out Doxycycline is in for chlamydia (Consider adherence)
Use monotherapy for gonorrhea (If chlamydia is ruled out)
Increase Ceftriaxone Doses (500mg-1000mg)
Is that PCN allergy really an “allergy”?
Be kind to your patient (Mix ceftriaxone with lidocaine or give IV)
Ensure EPT is available
References
Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187. doi: 10.15585/mmwr.rr7004a1. PMID: 34292926; PMCID: PMC8344968.
Workowski KA, Bolan GA; CDC. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64(No. RR-3). PMID:2604281
Barrow RY, Ahmed F, Bolan GA, Workowski KA. Recommendations for providing quality sexually transmitted diseases clinical services, 2020. MMWR Recomm Rep 2020;68(No. RR-5). PMID:31899459https://doi.org/10.15585/mmwr.rr6805a1
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2019. Gonorrhea. Atlanta: U.S. Department of Health and Human Services; April 2021.
Connolly KL, Eakin AE, Gomez C, Osborn BL, Unemo M, Jerse AE. Pharmacokinetic Data Are Predictive of In Vivo Efficacy for Cefixime and Ceftriaxone against Susceptible and Resistant Neisseria gonorrhoeae Strains in the Gonorrhea Mouse Model. Antimicrob Agents Chemother. 2019 Feb 26;63(3):e01644-18. doi: 10.1128/AAC.01644-18. PMID: 30642924; PMCID: PMC6395893.
Chisholm SA, Mouton JW, Lewis DA, Nichols T, Ison CA, Livermore DM. Cephalosporin MIC creep among gonococci: time for a pharmacodynamic rethink? J Antimicrob Chemother. 2010 Oct;65(10):2141-8. doi: 10.1093/jac/dkq289. Epub 2010 Aug 6. PMID: 20693173.
Wind CM, de Vries E, Schim van der Loeff MF, van Rooijen MS, van Dam AP, Demczuk WHB, Martin I, de Vries HJC. Decreased Azithromycin Susceptibility of Neisseria gonorrhoeae Isolates in Patients Recently Treated with Azithromycin. Clin Infect Dis. 2017 Jul 1;65(1):37-45. doi: 10.1093/cid/cix249. PMID: 28510723.
Gernert KM, Seby S, Schmerer MW, Thomas JC 4th, Pham CD, Cyr SS, Schlanger K, Weinstock H, Shafer WM, Raphael BH, Kersh EN; Antimicrobial-Resistant Neisseria gonorrhoeae Working Group *. Azithromycin susceptibility of Neisseria gonorrhoeae in the USA in 2017: a genomic analysis of surveillance data. Lancet Microbe. 2020 Aug;1(4):e154-e164. doi: 10.1016/S2666-5247(20)30059-8. PMID: 33005903; PMCID: PMC7527259.
