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 all gonococcal infection in children--
      • parenteral third-generation cephalosporin-- ceftriaxone (Rocephin)
    • All gonorrhea patients: should be given azithromycin (Zythromax) Laura doxycycline (Vibramycin, Doryx) for presumptive chlamydial infection