jueves, 26 de abril de 2012

tratamiento de Neisseria gonorrhoeae

Unfortunately, Neisseria gonorrhoeae has always readily developed resistance to antimicrobial agents: it became resistant to sulfanilamide in the 1940s, penicillins and tetracyclines in the 1980s, and fluoroquinolones by 2007.

A 250-mg intramuscular dose of ceftriaxone is most effective in curing gonococcal infections at both genital and extragenital sites.
One gram of azithromycin should also be given orally to cover other copathogens and to provide another
antimicrobial with activity against N. gonorrhoeae at a different molecular target. Doxycycline seems less preferable, since gonococcal strains with decreased susceptibility to cefixime currently exhibit tetracycline resistance as well. Oral cefixime should be reserved for situations that preclude ceftriaxone treatment. In patients who are allergic to cephalosporins, the only option is 2 g of azithromycin orally.

All patients treated for gonorrhea should routinely be offered condoms, referred for risk-reduction
counseling, and retested for gonorrhea 3 months later. Sex partners with whom the patient has had contact in the previous 2 months should be treated with ceftriaxone and azithromycin.

The Emerging Threat of Untreatable Gonococcal Infection
Gail A. Bolan, M.D., P. Frederick Sparling, M.D., and Judith N. Wasserheit, M.D., M.P.H.
N Engl J Med 2012; 366:485-487

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