Europe [61] | United Kingdom [62] | Germany [63] | Australia [64] | USA [65] | Canada [66] | |
---|---|---|---|---|---|---|
Recommended (first-line) regimens for anogenital infections a | Ceftriaxone 500 mg × 1 IM | Ceftriaxone 500 mg × 1 IM | Ceftriaxone 1 g × 1 IM/IV | Ceftriaxone 500 mg × 1 IM | Ceftriaxone 250 mg × 1 IM | Ceftriaxone 250 mg × 1 IM |
PLUS | PLUS | PLUS | PLUS | PLUS | PLUS | |
Azithromycin 2 g × 1 orallyb | Azithromycin 1 g × 1 orally | Azithromycin 1.5 g × 1 orally | Azithromycin 1 g × 1 orally | Azithromycin 1 g × 1 orally | Azithromycin 1 g × 1 orally | |
OR | ||||||
Cefixime 800 mg × 1 orally | ||||||
PLUS | ||||||
Azithromycin 1 g × 1 orally | ||||||
Alternative regimens for anogenital infections a | 1. Cefixime 400 mg × 1 orally | All the options below should be taken with Azithromycin 1 g × 1 orally.c | If IM/IV injection is not possible: | Alternative treatments are not recommended because of high levels of resistance, except for some remote Australian locations and severe allergic reactions. | If ceftriaxone is not available: | Spectinomycin 2 g × 1 IM |
PLUS | → Cefixime 400 mg × 1 orally. Only if an injection contra-indicated or refused. | Cefixime 800 mg × 1 orally | Cefixime 400 mg × 1 orally | PLUS | ||
Azithromycin 2 g × 1 orally. | → Spectinomycin 2 g × 1 IM. | PLUS | PLUS | Azithromycin 1 g × 1 orally | ||
Only if ceftriaxone not available or administration of injectable antimicrobials not possible or refused. | → Cefotaxime 500 mg × 1 IM or Cefoxitin 2 g × 1 IM PLUS probenecid 1 g × 1 orally. | Azithromycin 1.5 g × 1 orally | Azithromycin 1 g × 1 orally | OR | ||
2. Ceftriaxone 500 mg × 1 IM. | Other cephalosporins offer no advantage in terms of efficacy and pharmacokinetics over ceftriaxone or cefixime. | or if N. gonorrhoeae known to be susceptible: | Azithromycin 2 g × 1 orally | |||
Only if azithromycin not available or patient unable to take oral medication.c | → Cefpodoxime with caution at a dose of 400 mg × 1 orally. | → Cefixime 400 mg × 1 orally | ||||
3. Spectinomycin 2 g × 1 IM | → When an infection is known before treatment to be quinolone susceptible, ciprofloxacin 500 mg × 1 orally or ofloxacin 400 mg × 1 orally. | → Ciprofloxacin 500 mg × 1 orally or Ofloxacin 400 mg × 1 orally. | ||||
PLUS | → Azithromycin 1.5 g × 1 orally | |||||
Azithromycin 2 g × 1 orally. | ||||||
E.g., if resistance to extended-spectrum cephalosporins is identified or suspected, or patient has history of penicillin anaphylaxis or cephalosporin allergy. | ||||||
Recommended treatment for pharyngeal infections | Identical regimen as recommended for anogenital infections. | Identical regimen as recommended for anogenital infections. | Identical regimen as recommended for anogenital infections. | Identical regimen as recommended for anogenital infections. | Identical regimen as recommended for anogenital infections. | Ceftriaxone 250 mg × 1 IM |
OR if N. gonorrhoeae known to be quinolone susceptible: | OR if N. gonorrhoeae known to be susceptible: | PLUS | ||||
→ Ciprofloxacin 500 mg × 1 orally or Ofloxacin 400 mg × 1 orally. | → Ciprofloxacin 500 mg × 1 orally or Ofloxacin 400 mg × 1 orally. | Azithromycin 1 g × 1 orally | ||||
→ Azithromycin 1.5 g × 1 orally | Alternatives: | |||||
Cefixime 800 mg × 1 orally | ||||||
PLUS | ||||||
Azithromycin 1 g × 1 orally | ||||||
OR | ||||||
Azithromycin 2 g × 1 orally. | ||||||
Recommended regimen when extended-spectrum cephalosporin resistance identified or failure with recommended dual regimen | → Ceftriaxone 1 g × 1 IM | No recommendation. | No recommendation. | No recommendation. | → Retreatment with recommended dual regimen. | It is strongly recommended that treatment be guided by antimicrobial susceptibility test results to determine the appropriate antimicrobial agent in consultation with an expert in infectious diseases and local public health authorities. |
PLUS | → Gemifloxacin 320 mg × 1 orally | |||||
PLUS | ||||||
Azithromycin 2 g × 1 | ||||||
Azithromycin 2 g × 1 orally. | OR | |||||
→ Gentamicin 240 mg × 1 IM | Gentamicin 240 mg × 1 IM | |||||
PLUS | PLUS | |||||
Azithromycin 2 g × 1 orally.b | Azithromycin 2 g × 1 can be considered. |