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CDC Urges Shift to Cephalosporins for Gonorrhea

CDC Urges Shift to Cephalosporins for Gonorrhea



The incidence of fluoroquinolone- resistant gonorrhea continues to rise in the United States, and the CDC is now urging physicians to prescribe cephalosporins for patients with gonococcal infections (Table).

The CDC recently reported that the nationwide incidence of infections caused by fluoroquinolone-resistant Neisseria gonorrhoeae among heterosexual men has increased more than 10-fold since 2001—from 0.6% in 2001 to about 6.7% in 2006.1 In some cities, the rates were significantly higher, reaching 26.6% in Philadelphia and more than 20% in Honolulu and in some areas of California. Rates of fluoroquinolone-resistant infection among homosexual men were up even more, from 1.6% in 2001 to 38.3% in 2006.

About 340,000 new cases of gonorrhea are reported to US health authorities each year, but the CDC estimates that the actual number of new cases is about 700,000 per year. Experts are trying to determine the reason for the exponential rise in resistant cases. The incidence of gonorrhea declined considerably from the 1970s through the 1990s, but that decline seems to have leveled off.


Table — Updated recommended treatment regimens for uncomplicated gonococcal infections*†

  Site of infection   Recommended regimens   Alternative regimens  
  Cervix, urethra, or rectum   Ceftriaxone, 125 mg in a single IM dose
Cefixime, 400 mg in a single oral dose
Treatment for chlamydial infection if it has not been ruled out
  Spectinomycin, 2 g in a single IM dose
Cephalosporin, single-dose regimens§
  Pharynx   Ceftriaxone, 125 mg in a single IM dose
Treatment for chlamydial infection if it has not been ruled out
  * Updated treatment guidelines for disseminated gonococcal infection (Figure), pelvic inflammatory disease, and epididymitis are available at
For all adult and adolescent patients, regardless of travel history or sexual behavior. Information regarding management of these infections in patients with documented severe allergic reactions to penicillins or cephalosporins is available at
Not available in the United States.
§ Other single-dose cephalosporin regimens that are considered alternative treatment regimens against uncomplicated urogenital and anorectal gonococcal infections include ceftizoxime, 500 mg IM; or cefoxitin, 2 g IM, administered with probenecid, 1 g orally; or cefotaxime, 500 mg IM. Some evidence indicates that cefpodoxime, 400 mg, and cefuroxime axetil, 1 g, might be oral alternatives.
Adapted from Centers for Disease Control and Prevention. MMWR. 2007.1



1. Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR. 2007;56:332-336.

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