Medical Pharmacology Chapter 35  Antibacterial Drugs

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Sexually Transmitted Diseases:  Drug Treatment
  • Epididymitis

    • Affected age group: < 35 years old

    • Older age group or those who have had urinary tract instrumentation:

      • Causative agents:

        • Enteric gram-negative bacilli

          • May also cause urethritis or epididymitis in men practicing unprotected, inserted anal intercourse

        • Pseudomonas

    • Drug of choice:

      • Ofloxacin (Floxin)

        •  May be used in the absence of culture data

    • Alternative agent:

      • Ceftriaxone (Rocephin) (single IM dose followed by 10 day treatment with doxycycline (Vibramycin, Doryx)

  • Pelvic Inflammatory Disease

    • Causative Agents

      • Chlamydia trachomatis and Neisseria gonorrhoeae: responsible for about 2/3 of active cases

      • Other organisms included Mycoplasma hominis (other facultative agents and anaerobic bacteria can be present)

    • Inpatients:

      • Drugs of choice:

        •  Cefotetan (Cefotan) or cefoxitin (Mefoxin) plus doxycycline (Vibramycin, Doryx, contraindicated in pregnancy)

        •  Doxycycline (Vibramycin, Doryx) alone -- contraindicated in pregnancy

        • Or

        • Clindamycin (Cleocin) +gentamicin (Garamycin), followed by doxycycline (Vibramycin, Doryx)

      •  Alternative agents:

        • Ofloxacin (Floxin) + metronidazole (Flagyl)

        • Ampicillin (Principen, Omnipen)/sulbactam + doxycycline (Vibramycin, Doryx)

        • Ciprofloxacin + doxycycline (Vibramycin, Doryx,contraindicated in pregnancy) + metronidazole (Flagyl)

        • All combinations continued until improvement is observed: then doxycycline (Vibramycin, Doryx, contradicted in pregnancy) for a 14 day time course

    • Outpatients

      • Drugs of choice:

        • Ofloxacin (Floxin, contraindicated in pregnancy) + metronidazole (Flagyl)

        • Or

        • Ceftriaxone (Rocephin) Or

        • Cefoxitin (Mefoxin) + probenecid (Benemid)-- either cephalosporin, ceftriaxone (Rocephin) or cefoxitin (Mefoxin), followed by doxycycline (Vibramycin, Doryx, contraindicated in pregnancy)


        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.

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