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Originally Posted by ExNYer
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You need to do a bit more research before you swallow a mainstream media article on a technical subject.
First, we are NOT down to one antibiotic. Spectinomycin is still quite effective against gonorrhea, and is still used for that outside the US. The problem is that the only US manufacturer of spectinomycin stopped production, because of low sales, ten years ago, and the FDA doesn't want to allow foreign manufacturers that are not micromanaged by the FDA to distribute product in the US. (The current drug shortage crises (plural) were ALL caused by increased FDA regulation.)
Second, ceftriaxone is still very viable against gonorrhea. There are a few strains showing resistance, which is why (a) they doubled the recommended dose (from 125 mg to 250 mg) and (b) added the recommendation for 1000 mg azithromycin single dose or 100 mg doxycycline twice daily for a week. Doxycycline is in general NOT effective against gonorrhea, by itself, but it can help. More to the point, it is extremely effective against chlamydia, which is FREQUENTLY found cohabitating with gonorrhea. Azithromycin is also extremely effective against chlamydia. More below.
Azithromycin 1000 mg single dose by itself is not effective against gonorrhea. Azithromycin 2000 mg single dose, however, is. However, two grams of azithromycin is VERY hard on the stomach, which is the main reason it isn't routinelyused for gonorrhea. The latest treatment guidelines mention azithromycin 2000 mg single dose as an alternative for patients allergic to all cephalosporin (the drug class comprising ceftriaxone and cefixime).
Cefixime is not quite as effective against gonorrhea as ceftriaxone. It is still very effective. The problem with cefixime is that Japan bred a resistant strain, by using a 200 mg 3-day regimen instead of the 400 mg single-dose regimen that everyone else was using. That strain is now common enough that one cannot rely on cefixime killing a random gonorrhea infection, which is why they are now recommending test of cure a week later.
Another part of the problem was that cefixime was unavailable in the US for several years. Same story as spectinomycin. It is my understanding that it is again becoming available. It has been available all along overseas (and I have in the past routinely brought it back with me).
The recommendation for ceftriaxone AND azithromycin or doxycycline is actually not new. It has been in place for a few years now, SPECIFICALLY because of the high incidence of concurrent infection ("cohabitation", above) with gonorrhea and chlamydia. Physicians in the US have for some years now routinely treated presumptively for both bugs when either one showed up.
There's a related issue, that is not getting any airplay outside the CDC and the medical community. The labs that have in the past processed gonorrhea tests used to do it by culturing the bug. They're all switching over to nucleic acid amplification tests, that don't culture the bug. The problem with this is that culturing the bug is critical to doing antibiotic susceptibility testing. We are rapidly losing the lab capability to culture the bug, and find out which resistant strain we're dealing with.
Yes, I've been following this for some years now.
