http://www.cdc.gov/nchhstp/newsroom/docs/2012/GonorrheaTreatmentGuidelinesFactSheet8-9-2012.pdf
A few days ago the CDC sent out a notice informing providers that due to increasing resistance, cefexime (Suprax) is no longer the first line of therapy for gonorrhea. Many of you all will recall not too long ago
the fluoroquinolones lost favor as therapy due to resistance. As such, the current mainstay of suspected gonorrhea is ceftriaxone (Rocephin) injected.
Please remember that due to high coinfection rates, if you clinically suspect gonorrhea enough to treat for it, you should "assume" coinfection with chlamydia, and also prescribe zithromax or doxycycline. Depending on the study you cite, as many as 20-40% of people who are positive for gonorrhea will also test positive for chlamydia. So, thinking of one should lead to the other.
Of course, don't forget these are all notifiable diseases once the labs return. Use the standard health department report form and fax it to 919-250-3945. The most crucial item to fill out on the form is to be sure to tell the health department if the patient was treated.
This change will impact many of our express cares, as many providers liked Suprax as a "non shot" alternative to rocephin. The CDC article admits an ultra low chance of resistance, but when a "standard of care", precedent setting group like the CDC changes its first line therapy, all providers should be aware, since a second line treatment should include documentation as to why the first line was not used.
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