From CDC Recommended Regimen for Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum Among Adults and Adolescents
Ceftriaxone 500 mg* IM in a single dose for persons weighing <150 kg
* For persons weighing ≥150 kg, 1 g ceftriaxone should be administered.
Alternative Regimens If cephalosporin allergy:
Gentamicin 240 mg IM in a single dose PLUS Azithromycin 2 g orally in a single dose ________________________________________ If ceftriaxone administration is not available or not feasible:
Cefixime 800 mg* orally in a single dose
* If chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally 2 times/day for 7 days.
“An 800-mg oral dose of cefixime should be considered only as an alternative cephalosporin regimen because it does not provide as high, nor as sustained, bactericidal blood levels as a 500-mg IM dose of ceftriaxone. Furthermore, it demonstrates limited efficacy for treatment of pharyngeal gonorrhea (92.3% cure; 95% CI: 74.9%–99.1%);
Changes in cefixime MICs can result in decreasing effectiveness of cefixime for treating urogenital gonorrhea. Furthermore, as cefixime becomes less effective, continued used of cefixime might hasten the development of resistance to ceftriaxone, a safe, well-tolerated, injectable cephalosporin and the last antimicrobial known to be highly effective in a single dose for treatment of gonorrhea at all anatomic infection sites. Other oral cephalosporins (e.g., cefpodoxime and cefuroxime) are not recommended because of inferior efficacy and less favorable pharmacodynamics”
I think some docs (I think Scott Weingart, for example, and others) are much more aggressive with status epilepticus. after two rounds of benzo's they go right to propofol or ketamine, secure the airway , stop the seizures, with the thought that every minute of seizure beyond 5 is detrimental (and harder to control) and therefore skip the trials of keppra or depakon or other second line meds. just a thought...
the other episode Tom that I remember is EM:RAP October 2020 with Justin Morgenstern, MD "Status Epilipticus Revisited." I think one of the big points was not using large does of your benzodiazepine up front (0.1 mg/kg, ie 7mg in your generic 70kg adult) and then yes very early adjuncts - in fact i recall just giving the levitiracetam etc early on because the pt is gonna need it anyway once the seizure is controlled. i think there was one other (no by SW) but it eludes me
and as you mentioned "thank you again!!" to the whole EM:RAP crew
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Ross C. - November 26, 2021 9:49 AM
If patient prefers oral meds, is there an alternative for GC infection to give?
Sean N. - November 29, 2021 10:54 AM
Hi Ross,
Thank you for the comment
Due to concern of resistance, oral cefixime is not recommended unless ceftriaxone is not available or feasible. See below from CDC guidelines
https://www.cdc.gov/std/treatment-guidelines/gonorrhea-adults.htm
From CDC Recommended Regimen for Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum Among Adults and Adolescents
Ceftriaxone 500 mg* IM in a single dose for persons weighing <150 kg
* For persons weighing ≥150 kg, 1 g ceftriaxone should be administered.
Alternative Regimens
If cephalosporin allergy:
Gentamicin 240 mg IM in a single dose
PLUS
Azithromycin 2 g orally in a single dose
________________________________________
If ceftriaxone administration is not available or not feasible:
Cefixime 800 mg* orally in a single dose
* If chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally 2 times/day for 7 days.
“An 800-mg oral dose of cefixime should be considered only as an alternative cephalosporin regimen because it does not provide as high, nor as sustained, bactericidal blood levels as a 500-mg IM dose of ceftriaxone. Furthermore, it demonstrates limited efficacy for treatment of pharyngeal gonorrhea (92.3% cure; 95% CI: 74.9%–99.1%);
Changes in cefixime MICs can result in decreasing effectiveness of cefixime for treating urogenital gonorrhea. Furthermore, as cefixime becomes less effective, continued used of cefixime might hasten the development of resistance to ceftriaxone, a safe, well-tolerated, injectable cephalosporin and the last antimicrobial known to be highly effective in a single dose for treatment of gonorrhea at all anatomic infection sites. Other oral cephalosporins (e.g., cefpodoxime and cefuroxime) are not recommended because of inferior efficacy and less favorable pharmacodynamics”
Rick M. - November 30, 2021 5:31 PM
Doxycycline 100 mg PO BID also treats syphilis. You just have to give it for a longer period of time.
tom f. - December 1, 2021 7:33 AM
excellent review team, thank you so much.
I think some docs (I think Scott Weingart, for example, and others) are much more aggressive with status epilepticus. after two rounds of benzo's they go right to propofol or ketamine, secure the airway , stop the seizures, with the thought that every minute of seizure beyond 5 is detrimental (and harder to control) and therefore skip the trials of keppra or depakon or other second line meds.
just a thought...
thank you again!!
tom fiero, merced, ca
Sean R. - December 6, 2021 6:57 AM
the other episode Tom that I remember is EM:RAP October 2020 with Justin Morgenstern, MD "Status Epilipticus Revisited." I think one of the big points was not using large does of your benzodiazepine up front (0.1 mg/kg, ie 7mg in your generic 70kg adult) and then yes very early adjuncts - in fact i recall just giving the levitiracetam etc early on because the pt is gonna need it anyway once the seizure is controlled. i think there was one other (no by SW) but it eludes me
and as you mentioned "thank you again!!" to the whole EM:RAP crew