Urethritis or cervicitis

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Chlamydia trachomatis Ureaplasma urealyticum Neisseria gonorrhoeae

Ceftriaxone 125 mg IM x 1 + doxycycline 100 mg PO bid x 7 d OR

Azithromycin 2 g PO x 1

Ciprofloxacin 500 mg x 1 + doxycycline2 100 mg PO bid x 7 d OR

Ciprofloxacin 500 mg x 1 + erythromycin2 500 mg PO qid x 7 d

Quinolones do not eradicate incubating syphilis. Evaluate and treat sexual partners. Test for syphilis and HIV. Due to increased prevalence of fluoroquinolone-resistant Neisseria gonorrhoeae the CDC no longer recommends fluoroquinolones for the treatment of gonorrhea in men who have sex with men

1 Ciprofloxacin may be used if susceptibility documented.

2 Pregnant women allergic to penicillin:

Chlamydia trachomatis - erythromycin stearate 500 mg PO qid. Neisseria gonorrhoeae - spectinomycin 2 g IM x 1.

Clinical Setting

Empiric Therapy

Likely Pathogens

Directed Therapy

Usual Duration

Community

Postneurosurgical/ posttraumatic

Vancomycin + ceftriaxone

Vancomycin + ceftazidime

Immunocompromised

Ceftriaxone + vancomycin + ampicillin

Pneumococcus Meningococcus Haemophilus influenzae

Staphylococcus epidermidis Staphylococcus aureus GNB (Pseudomonas aeruginosa) Pneumococcus

Listeria sp

GNB (Pseudomonas aeruginosa) Pneumococcus

Penicillin G Penicillin G Ceftriaxone

Vancomycin Oxacillin5 Ceftazidime + gentamicin6

Penicillin G

Ampicillin + gentamicin Ceftazidime + gentamicin6 Penicillin G2

1 If elderly or immunocompromised, consider Listeria and add ampicillin.

2 Substitute ceftriaxone or vancomycin if isolate is resistant to penicillin.

3 If isolate is ß-lactamase-negative, ampicillin may be substituted.

4 Substitute oxacillin if susceptible.

5 Substitute vancomycin if oxacillin-resistant.

6 Substitute tobramycin if resistant to gentamicin.

7 Three weeks recommended for GNB.

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