GoodGirl
_____________
Topics: 88
Posts: 1,175
|
___________________
*Never argue with a fool, people might not know the difference* PRIORITIZE & SIMPLIFY. Do or do not, there is no 'try'.
|
| new_n_lost
Politically InCorrect
Topics: 644
Posts: 5,920
|
D
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| taipei817
Forum Newbie
Topics: 1
Posts: 68
|
B
wana cover both gonococcus and chlamydia
|
| lakshya_0_7
Forum Elite
Topics: 19
Posts: 240
|
B ..........
|
| PGI2alpha
Forum Elite
Topics: 7
Posts: 446
|
D
|
| Tiff
Forum Guru
Topics: 50
Posts: 505
|
taipei817 wrote:
B
wana cover both gonococcus and chlamydia
Believe that's right. Should cover both. 
|
| jean robert
Forum Guru
Topics: 145
Posts: 598
|
B
___________________
Great works are performed not by strength, but by perseverance.
|
| bactitech
Forum Elite
Topics: 25
Posts: 475
|
2007 Guidelines do NOT include fluoroquinolones (i.e. ciprofloxacin, levofloxacin, etc.) at all because of resistance - if your textbooks are telling you this they are OUT OF DATE:
http://www.cdc.gov/std/treatment/2006/updated-reg...
Recommended Regimens
Ceftriaxone 125 mg IM in a single dose
OR
Cefixime†400 mg orally in a single dose or 400 mg by suspension (200 mg/5ml)
PLUS
TREATMENT FOR CHLAMYDIA IF CHLAMYDIAL INFECTION IS NOT RULED OUT
* These regimens are recommended for all adult and adolescent patients, regardless of travel history or sexual behavior.
† The tablet formulation of cefixime is currently not available in the United States
There are caveats to this, however, where quinolones can be used - scroll down on the page listed above.
___________________
Clinical Microbiology since 1974
|
| GoodGirl
_____________
Topics: 88
Posts: 1,175
|
___________________
*Never argue with a fool, people might not know the difference* PRIORITIZE & SIMPLIFY. Do or do not, there is no 'try'.
|
| new_n_lost
Politically InCorrect
Topics: 644
Posts: 5,920
|
GoodGirl wrote:
If that is the reasoning they are coming up with, then its a bit stretched. According to Katzung Azithromycin covers both Gonococci and Clamydia. So its a bit excessive to give the 2 drugs at the same time. Yes the Fluoroquinolones are now abandoned in the Rx of both Gonococcal and non gonococcal UTIs but Azithromycin covers the both organisms and is more effective if considered as an alternative route to Penicillin.
So in my opinion its should be A instead of B as Cipro is now not used under the current guidelines.
Edited by new_n_lost on 04/26/08 - 09:09 PM. Reason: spell & grammer check
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| GoodGirl
_____________
Topics: 88
Posts: 1,175
|
If this is the truth into the hell with wiketestprep!!!!  
Thanks NNL .
___________________
*Never argue with a fool, people might not know the difference* PRIORITIZE & SIMPLIFY. Do or do not, there is no 'try'.
|
| GoodGirl
_____________
Topics: 88
Posts: 1,175
|
My simple question is now : if there would be answer like:
Cefitriaxon + Doxycycline.
Would I pick up this one rather than Azithromycin? I got so lost in those long cdc guidelines.
So it is still correct to pick up the answer , where drug(s) empirically cover both Gono & Chlamydia ? Even in such a case of question where clearly talk only about + gono infection .
___________________
*Never argue with a fool, people might not know the difference* PRIORITIZE & SIMPLIFY. Do or do not, there is no 'try'.
|
| bactitech
Forum Elite
Topics: 25
Posts: 475
|
http://www.medscape.com/viewarticle/508902_1 - Optimizing Treatment of antimicrobial-resistant GC
http://www.medscape.com/viewarticle/543426 - STD treatment guidelines 2006
Found this quote in this extensive article:
"All treatment regimens should be effective against N. gonorrhoeae and C. trachomatis because negative endocervical screening for these organisms does not rule out upper reproductive tract infection." I couldn't find anything about Pen allergic patients except under the Syphilis treatment section. This involved desensitization of the patinet, since Penicillin is really the only treatment.
If you read the section I quoted from the CDC again, I think it implies that you would need two drugs to cover for GC and Chlamydia. It says "PLUS treatment for Chlamydia."
http://www.vhpharmsci.com/PDTM/Monographs/ceftria... - treat patients with sensitivity to Penicillin with caution.
Azithromycin is not in the same class as Doxycycline, which is a tetracycline.
Most labs do not culture for GC any more. They use DNA amplification testing. We do both, depending on the specimen the doc submits, but the DNA amp is much more sensitive. Lots of docs living in the past out there.....
I'm not sure how sensitivity testing is performed with GC. I've never done it. The organism itself is very sticky and hard to grow in a broth culture in order to make a suspension to use for dropping discs. Very few labs monitor susceptibility patterns now because of the change in testing.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4937a1... - this article points out that the only reason they were able to determine antimicrobial sensi patterns was because the Hawaii State Health Dept. did these and found resistance patterns. This was in 1999. Many many more labs have dropped culturing since that time. We do virtually NO cultures on males. All specimens submitted are either swabs or mostly urine specimens for DNA amplifcation testing.
Just thought I'd throw all this at you to cloud your perspectives. This is a difficult issue.
___________________
Clinical Microbiology since 1974
|
| new_n_lost
Politically InCorrect
Topics: 644
Posts: 5,920
|
High Rates of Co Infection have to be considered when treating Gonococcal Infection. Therefore the use of Third generation of cephalosporins is recommended as it kills both. Tetracyclines and Fluoroquinolones are now discarded due to the high level of resistence shown by the strains of th eboth bacteria. Azithromycin is still the best choice.
USMLE Rule 1: DONT ASSUME ANYTHING EVERYTHING IS THERE TO DERIVE AT THE ANSWER. So no assumptions. If they ask you same question just pick Rocephin and if penicillin allergic then Azithromycin and move on.
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| Tiff
Forum Guru
Topics: 50
Posts: 505
|
GoodGirl wrote:If this is the truth into the hell with wiketestprep!!!! Thanks NNL .
It's likely that this is an older question as changes to the recommended regimen for gonorrhea were only made in April of 2007. - making Azithromycin today the most appropiate answer.
|
| bactitech
Forum Elite
Topics: 25
Posts: 475
|
http://www.cdc.gov/std/Treatment/2006/updated-reg...
"Since there are limited data regarding alternative regimens for treating gonorrhea among persons who have documented severe cephalosporin allergy, expert infectious diseases consultation is recommended; the best available treatment option is cephalosporin treatment following desensitization. If desensitization is not an option, azithromycin may be considered. Azithromycin 2 grams orally is effective against uncomplicated gonococcal infection, but concerns over emerging antimicrobial resistance to macrolides should restrict its use to limited circumstances. "
___________________
Clinical Microbiology since 1974
|
| bactitech
Forum Elite
Topics: 25
Posts: 475
|
http://tinyurl.com/6otgpc - link to new Medscape article with all the latest info from CDC regarding GC treatment.
___________________
Clinical Microbiology since 1974
|
| bactitech
Forum Elite
Topics: 25
Posts: 475
|
http://tinyurl.com/4hncvp - Cefixime is now available in pill form again under the brand name of Suprax.
"May 1, 2008 — The CDC is getting the word out that a pill to treat gonorrhea is back on U.S. pharmacy shelves.
The CDC says that cefixime is the only pill it recommends for treating what is called "uncomplicated" gonorrhea. That means the sexually transmitted disease (STD) has not spread to the blood or central nervous system. The pill form of cefixime has not been available in the U.S. since 2002, although the drug has been available in liquid form.
There's been pressure to have a pill treatment since certain antibiotics (in the fluoroquinolone class) have become widely resistant to gonorrhea.
Studies linking antibiotic resistance and gonorrhea prompted the CDC last year to drop its recommendation of fluoroquinolone antibiotics as a gonorrhea treatment..."
___________________
Clinical Microbiology since 1974
|
|
| |
| | | | | | | | | | | | | | | | | | |
