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.
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
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.
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!
To join the conversation, you need to subscribe.
Sign up today for full access to all episodes and to join the conversation.
Challenging Foleys, Conversations, and IntubationsFull episode audio for MD edition245:15 min - 342 MB - M4AEM:RAP 2017 August Aussie EditionAustralian16:18 min - 22 MB - MP3EM:RAP 2017 August German EditionDeutsche69:31 min - 96 MB - MP3EM:RAP 2017 August French EditionFrançais41:16 min - 57 MB - MP3EM:RAP 2017 August Spanish EditionEspañol153:43 min - 211 MB - MP3EM:RAP 2017 August Board Review Answers234 KB - PDFEM:RAP 2017 August Board Review Questions180 KB - PDFEM:RAP 2017 August MP3315 MB - ZIPEM:RAP 2017 August Spanish Summary1 MB - PDFEM:RAP 2017 August Summary718 KB - PDF
To earn CME for this chapter, you need to subscribe.
Sign up today for full access to all episodes and earn CME.
6 AMA PRA Category 1 Credits™ certified by CEME (EM:RAP)
Michael R. - August 25, 2017 11:49 AM
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. - August 26, 2017 5:06 AM
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. - August 29, 2017 11:01 AM
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. - August 30, 2017 5:48 AM
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!