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
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
all gonococcal infection in
children--
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.