Drug of Choice for Chlamydia ?

R

ruiner

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• Jun 11, 2012

• #2

azithromycin (for chlamydiae) + ceftriaxone (for high occurrence of coinfection with neisseria)

 

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• Jun 11, 2012

• #3

I got a quick follow up question. FA states that macrolides are also effective against Neisseria so why add ceftriaxone?

 

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ruiner

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• Jun 11, 2012

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hmm honestly not really sure. thinking maybe they meant just for meningococci? sorry can't give a better answer, but positive on my original answer. was a tech in the ER before i started school and it was given out nightly!

 

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HelpPleaseMD

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• Jun 11, 2012

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Yea your absolutely right. I saw the azithromycin / ceftriaxone combo more than a couple of times in UWORLD. Was just curious after reviewing FA

 

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DoctwoB

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• Jun 11, 2012

• #6

HelpPleaseMD said:

I got a quick follow up question. FA states that macrolides are also effective against Neisseria so why add ceftriaxone?

Click to expand...

High azithro resistance in gonorrhea

 

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• Jun 11, 2012

• #7

HelpPleaseMD said:

I got a quick follow up question. FA states that macrolides are also effective against Neisseria so why add ceftriaxone?

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Used to be able to do that. Also used to be able to use a fluoroquinolone for monotherapy for GC + Chlamydia (not even that long ago--I was taught that when I went through ID in 2006). No more due to the crazy resistance gonococcus is developing.

 

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HelpPleaseMD

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• Jun 11, 2012

• #8

thanks

 

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OveractiveBrain

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• Jun 12, 2012

• #9

HelpPleaseMD said:

Is it tetracyclines or macrolides in a typical patient with no other problems.

nm I found the answer. its macrolides because its a one time treatment thing as opposed to tetracyclines

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Uh... in the real world, if you find urethral discharge, you give Ceftriaxone and Doxy. Just sayin...

though when you're old enough to perscribe for yourself, Cipro Doxy or Cipro Azithro work too, but they are backups

 

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Ok2Panic

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• Jun 12, 2012

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I thought I read somewhere that azithro was preferred because you can give it in a single dose to treat chlamydia? Did I make that up?

 

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• Jun 13, 2012

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Yes.

Chlamydia - single-dose azithro or doxy (since it's intracellular, you need to use a protein synthesis inhibitor, like a macrolide or a tetracycline)
Gonorrhea - single-dose cefiximine or ceftriazone (extracellular, so cefalosporins are legit)

I think you need to assume coinfection with urethritis, which is why you should use both. Also, gonorrhea tends to change its pilus a lot, so reinfection may occur (got a UWorld question on this). But, this is not true of neisseria meningitidis (I'm bad at spelling - sorry!), for which there is a vaccine.

 

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futuredoctor10

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• Jun 13, 2012

• #12

ButterIsMagical said:

Yes.

Chlamydia - single-dose azithro or doxy (since it's intracellular, you need to use a protein synthesis inhibitor, like a macrolide or a tetracycline)
Gonorrhea - single-dose cefiximine or ceftriazone (extracellular, so cefalosporins are legit)

I think you need to assume coinfection with urethritis, which is why you should use both. Also, gonorrhea tends to change its pilus a lot, so reinfection may occur (got a UWorld question on this). But, this is not true of neisseria meningitidis (I'm bad at spelling - sorry!), for which there is a vaccine.

Click to expand...

👍

Very high yield, well-summarized post. There were so many UWorld questions on treating Chlamydia and Gonorrhea empirically as co-infection...maybe 3 or 4... e.g. "if person is treated with ceftriaxone and not getting better, why?"

 

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