ALVARO GARZA, M.D., M.P.H. HEALTH OFFICER SAN BENITO COUNTY MARIA C. CORONA INTERIM DIRECTOR PUBLIC HEALTH SERVICES Healthy People in Healthy Communities FOR IMMEDIATE RELEASE CONTACT: Allison Griffin, PHN September 10, 2012 Communicable Disease Nurse, (831) 637-5367 To: Primary Healthcare Providers, OB/GYNs, Community Clinics & Emergent Care Health Update: New GC Treatment Guidelines from the CDC
Since December 2010, the Centers for Disease Control and Prevention (CDC) have recommended that health care providers treat uncomplicated gonorrhea (GC for gonococcal) infections with dual antibiotic therapy: ceftriaxone 250 mg intramuscularly (IM) plus azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days. If ceftriaxone was not an option, the oral antibiotic cefixime at a dose of 400 mg with either azithromycin or doxycycline was also a recommended therapy.
In a recent Morbidity and Mortality Weekly Report (MMWR), the CDC released new data indicating an increase in the proportion of GC isolates tested through the GC Isolate Surveillance Project (GISP) with “alert values” to cephalosporin antibiotics including cefixime and ceftriaxone. The alert values serve as a warning sign that cephalosporin resistance may be developing. In 2011, the highest proportions of GC isolates with elevated minimum inhibitory concentrations (MICs) to cefixime are in the west (3.2%) and among men who have sex with men (MSM) (3.8%). It is important to note that these are only a warning sign of resistance -- cases of treatment failure due to cephalosporin resistance have not yet been seen in the U.S.
Given these new data, the CDC have changed the status of oral cefixime from a recommended to an alternative treatment. Because IM cephalosporins are less likely to induce resistance, dual therapy with ceftriaxone plus azithromycin or doxycycline is now the only recommended therapy for uncomplicated GC infections. The use of azithromycin as the second antimicrobial is preferred to doxycycline because of the advantages of single-dose therapy and the higher prevalence of tetracycline resistance. For patients allergic to cephalosporins, azithromycin 2 g orally in a single dose is still considered an alternative treatment regimen.
The full report, “Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections” (MMWR Weekly, August 10, 2012 / 61(31);590-594), is available online:
The California Gonorrhea Treatment Guidelines will be updated to reflect new national guidance and posted online:
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