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Pharmacology Rounds – Gonorrhea Gets Some Muscle

Rob Orman, MD and Bryan Hayes, PharmD, DABAT
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05:08
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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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00:28

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EM:RAP 2017 August Summary 718 KB - PDF

Gonorrhea is no longer the ‘easy treatment’ pushover it used to be.

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Michael R. -

250mg ceftriaxone IM and 1gm azithromycin PO covers syphilis? Are you sure that is a reasonable approach . . .? My understanding is that you need either a longer duration of ceftriaxone (10-14 days) or the higher dose of azithro (2gm PO) that most patients cannot tolerate.

Bryan H. -

Hi Michael, thanks for your question. Our discussion focused largely on gonorrhea, for which ceftriaxone 250 mg IM + azithromycin 1 gm PO is the CDC-recommended regimen in adults. The standard treatment for syphilis is Benzathine penicillin G 2.4 million units IM in a single dose. https://www.cdc.gov/std/tg2015/default.htm

Michael R. -

I agree - my point was that the segment summary said that the ceftriaxone 250 mg IM + azithromycin 1 gm PO also covers syphilis, which is not accurate (according to the CDC recommendations you cite above). Given the national shortage of benzathine penicillin G, we may need to resort to other regimens at some point in the near future, but I suppose that is a topic for another segment.

Anand S., M.D. -

Michael - thanks for raising this. In Bryan's defense, it was my comments at the end of the segment as Bryan didn't even address Syphilis. I was taught that ceftriaxone covers syphilis but, it seems that this is a debatable area. Bryan and I will be doing a deep dive into the topic soon!

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Challenging Foleys, Conversations, and Intubations Full episode audio for MD edition 245:15 min - 342 MB - M4AEM:RAP 2017 August Aussie Edition Australian 16:18 min - 22 MB - MP3EM:RAP 2017 August German Edition Deutsche 69:31 min - 96 MB - MP3EM:RAP 2017 August French Edition Français 41:16 min - 57 MB - MP3EM:RAP 2017 August Spanish Edition Español 153:43 min - 211 MB - MP3EM:RAP 2017 August Board Review Answers 234 KB - PDFEM:RAP 2017 August Board Review Questions 180 KB - PDFEM:RAP 2017 August MP3 315 MB - ZIPEM:RAP 2017 August Spanish Summary 1 MB - PDFEM:RAP 2017 August Summary 718 KB - PDF

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