Active Ingredients: Azithromycin
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In, the CDC hosted a meeting with expert consultants to review the most recent data on gonococcal antimicrobial susceptibility, review the most recent data on treatment effectiveness, and make recommendations for the management of gonorrhea in adolescents and adults in the United States.
This paper summarizes the evidence discussed at the meeting and the rationale for the CDC Sexually Transmitted Diseases STD treatment guidelines for gonococcal infections in adolescents and adults.
In preparation for the meeting, 9 key questions on the management of gonococcal infections were developed based on input solicited from partners at state and local health departments and expert consultants.
References listed in the retrieved articles were also searched for other relevant articles and abstracts. Additional data on national or regional gonococcal susceptibility were obtained from reports published on the websites of internationally recognized public health agencies and directly from the US Gonococcal Isolate Surveillance Project GISP.
GISP is a sentinel surveillance system, located in 25—30 cities throughout the United States, that monitors gonococcal antimicrobial susceptibility among urethral isolates obtained from men with urethritis.
Preliminary answers to the 9 key questions and proposed recommendations were drafted based on available evidence, when data were insufficient, expert opinion.
Below is a list of key questions discussed, a summary of the data available for each question, and an overview of the discussion and recommendations resulting from each question.
These data and revised recommendations are included in the following discussion.
Prophylactic Antibiotics Although prophylactic antibiotics can prevent some TD, the emergence of antimicrobial resistance has made the decision of how and when to use antibiotic prophylaxis for TD difficult. The prophylactic antibiotic of choice has changed over the past few decades as resistance patterns have evolved.
Fluoroquinolones have been the most effective antibiotics for the prophylaxis and treatment of bacterial TD pathogens, but increasing resistance to these agents among Campylobacter and Shigella species globally limits their potential use.
In addition fluoroquinolones are associated with tendinitis and an increased risk of Clostridioides difficile infection, and current guidelines discourage their use for prophylaxis.
Alternative considerations include azithromycin, rifaximin, and rifamycin SV. At this time, prophylactic antibiotics should not be recommended for most travelers. The risks associated with the use of prophylactic antibiotics should be weighed against the benefit of using prompt, early self-treatment with antibiotics when moderate to severe TD occurs, shortening the duration of illness to 6—24 hours in most cases.
In adult travelers who are otherwise healthy, severe dehydration resulting from TD is unusual unless vomiting is prolonged.
Nonetheless, replacement of fluid losses remains an adjunct to other therapy and helps the traveler feel better more quickly. Travelers should remember to use only beverages that are sealed, treated with chlorine, boiled, or are otherwise known to be purified.
For severe fluid loss, replacement is best accomplished with oral rehydration solution ORS prepared from packaged oral rehydration salts, such as those provided by the World Health Organization. ORS is widely available at stores and pharmacies in most developing countries.
ORS is prepared by adding 1 packet to the indicated volume of boiled or treated water—generally 1 liter. In mild cases, rehydration can be maintained with any palatable liquid including sports drinks, although overly sweet drinks, such as sodas, can cause osmotic diarrhea if consumed in quantity.
Antimotility Agents Antimotility agents provide symptomatic relief and are useful therapy in TD. Synthetic opiates, such as loperamide and diphenoxylate, can reduce frequency of bowel movements and therefore enable travelers to ride on an airplane or bus.
Loperamide appears to have antisecretory properties as well. Antimotility agents alone are not recommended for patients with bloody diarrhea or those who have diarrhea and fever.
Loperamide can be used in children, and liquid formulations are available. Antibiotics Antibiotics are effective in reducing the duration of diarrhea by about a day in cases caused by bacterial pathogens that are susceptible to the particular antibiotic prescribed.
However, there are concerns about adverse consequences of using antibiotics to treat TD.