Overview

• Chlamydia: Drugs of choice

  • About the organism

  •  Urethritis, cervicitis, conjunctivitis, proctitis

    • Primary drugs:

      •  azithromycin (Zythromax)

        •  single dose usually effective for uncomplicated urethral or cervical infection caused by Chlamydia trachomatis

        •  azithromycin (Zythromax): expensive

        • Or

      •  doxycycline (Vibramycin, Doryx) {alternatives: tetracycline (Achromycin) or minocycline (Minocin)}

        •  seven-day treatment protocol

        •  less costly, patient compliance a concern

    •  Alternative drugs:

      •  ofloxacin (Floxin) { contraindicated in pregnancy)

      •   erythromycin {erythromycin estolate (Ilosone) contraindicated in pregnancy}

  • Nonchlamydial nongonococcal urethritis (NGU) in men

    •  Causative agents: Ureaplasma urealyticum, Mycoplasma genitalium et al.

    •  Treatment: normally responsive to azithromycin (Zythromax) or doxycycline (Vibramycin, Doryx)

      • Alternative treatment: erythromycin or ofloxacin (Floxin)

  • Infection in pregnancy:

    • Primary drug

      •  amoxicillin (Amoxil Polymox)

      •  probably safe/effective

    • Alternative drugs

      •  azithromycin (Zythromax) -- safety and pregnancy not established, but probably safe & effective (limited clinical experience with azithromycin (Zythromax) in pregnancy)

      •  erythromycin {erythromycin estolate (Ilosone) contraindicated in pregnancy}

        • Seven-day erythromycin treatment course may be poorly tolerated by patients -- gastrointestinal effects

    •  Contraindications:

      •  not for use in pregnancy: doxycycline (Vibramycin, Doryx), other tetracycline (Achromycin) and fluoroquinones

  •  Neonatal:  infant conjunctivitis/pneumonia risk if mother has Chlamydia trachomatis

    •  Ophthalmic tetracycline (Achromycin), erythromycin, silver nitrate: not reliable for prevention of newborn ocular chlamydial infection

    • Opthalmia

      •  Primary drug:

        • erythromycin 14 day treatment course

      •  Alternative drug:

        • azithromycin (Zythromax)

    • Pneumonia:

      •  Primary drug:

        • erythromycin

• Gonorrhea

  • About the organism

  • Drugs of choice

    • Urethral, cervical, rectal, pharyngeal

    • Primary drugs:  highly effective with single, oral doses (uncomplicated anogenital & pharyngeal infection {even with penicillin-and tetracycline (Achromycin)-resistant Neisseria gonorrhoeae )

      •  cefixime (Suprax)

      •  ciprofloxacin (Cipro) (contraindicated in pregnancy)

      •  ofloxacin (Floxin) (contraindicated in pregnancy)

      •  ceftriaxone (Rocephin)-- single injection

      •  Fluoroquinone-resistant Neisseria gonorrhoeae strains (increasingly common in the USA {more common in Asia})-- susceptible to cefixime (Suprax) & ceftriaxone (Rocephin)

    • Alternative drug:

      •  spectinomycin (Trobicin)

        •  unreliable against pharyngeal gonococcal infection; may be used to manage pregnant women allergic to beta-lactam antibiotics

    • Drug Management of gonococcal opthalmia, bacteremia, arthritis, or meningitis in adults and and all gonococcal infection in children

      • Parenteral third-generation cephalosporin, eftriaxone (Rocephin)

    • All gonorrhea patients: should be given azithromycin (Zythromax) Laura doxycycline (Vibramycin, Doryx) for presumptive chlamydial infection

    Reference:"Drugs for Sexually Transmitted Infections", The Medical Letter, vol. 41 (issue 1063), September, 24, 1999, Published by the Medical Letter, Inc, New Rochelle, N.Y.