What are treatment options for patients who are cephalosporin allergic?

Updated: Jun 15, 2021
  • Author: Shahab Qureshi, MD, FACP; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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In patients who are cephalosporin allergic, a single 240 mg IM dose of gentamicin plus a single 2 g oral dose of azithromycin is an option. [6] . Be aware of treatment-limiting adverse gastrointestinal adverse effects (eg, vomiting) of both of the cephalosporin-allergic regimens, 7.7% and 3.3%, respectively. A single 800 mg oral dose of cefixime is an alternative regimen. However, cefixime does not provide as high, or as sustained, bactericidal blood levels as does ceftriaxone and demonstrates limited treatment efficacy for pharyngeal gonorrhea.

Another alternative regimen for patients intolerant of cephalosporins include is spectinomycin (2 g IM). Spectinomycin may be costly and is currently unavailable in the United States.

A test-of-cure is unnecessary for persons with uncomplicated infection, except for persons with pharyngeal gonorrhea, a test-of-cure is recommended using culture or nucleic acid amplification tests 7–14 days after initial treatment, regardless of the treatment regimen. CDC advises that clinicians should perform susceptibility testing in patients who fail to respond to treatment and notify their local public health STD program. [61]

Monotherapy with azithromycin is not recommended because of concerns over the ease with which N gonorrhoeae can develop resistance to macrolides, and because several studies have documented azithromycin treatment failures. Strains of N gonorrhoeae circulating in the United States are not adequately susceptible to penicillins, tetracyclines, or older macrolides (eg, erythromycin); thus, use of these antimicrobials cannot be recommended. [1]

Gonococcal pharyngeal infections may be more challenging to eradicate than infections involving urogenital and anorectal areas. [62]

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