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Alternatives to spectinomycin in the treatment of acute gonorrhea

The CDC released a report on the cessation of production of the drug spectinomycin (registered in United States under the trade names Kirin and Trobitsin in the United States), which was recommended for the treatment of gonorrhea in people who have contraindications to the use of cephalosporins and fluoroquinolones.

There are only a few conditions under which the use of spectinomycin is preferred over other antibiotics. The indications for use of spectinomycin are (1) the treatment of gonorrhea in pregnant women with a confirmed allergic reaction to cephalosporins (fluoroquinolones are contraindicated during pregnancy), and (2) the treatment of gonorrhea in patients allergic to cephalosporins living in areas where a high level of resistance Neisseria gonorrhoeae to fluoroquinolones.

There are currently no studies confirming the effectiveness of alternative drugs in pregnant women. Thus, in pregnant women with allergic reactions to cephalosporins, treatment for gonorrhea should include desensitization to cephalosporins. Although azithromycin at a dose of 2 g / day is once effective in the treatment of uncomplicated gonococcal infection, there are no data confirming the efficacy and safety of this treatment in women pregnant. In people who, in addition to a gonococcal infection, a chlamydia infection is detected, it is necessary to prescribe 500 mg of erythromycin 4 times a day for 7 days or 500 mg of amoxicillin 3 times a day for 7 days.

The level of resistance of Neisseria gonorrhoeae to fluoroquinolones is quite high in many countries of the Asia-Pacific region. In the United States, unique strains of gonococci are resistant to fluoroquinolones.

There are no standardized alternative treatment regimens for gonococcal infection in areas with high resistance of Neisseria gonorrhoeae to fluoroquinolones in people with a confirmed allergy to cephalosporins.

Despite the fact that the treatment of gonorrhea with 2 g / day of azithromycin is approved by the FDA, and in clinical studies, it is proven that the effectiveness of this diet is 97.2 to 99.9% in the treatment of urogenital infections, the current CDC recommendations do not recommend the use of azithromycin routinely in non-pregnant women people because of gastrointestinal disorders that occur when taking such a dose.