Neisseria gonorrhoeae is isolated from a urethral swab on Thayer-Martin medium. The antibiogram shows resistance to penicillin, azithromycin, and ciprofloxacin. According to current WHO/Indian treatment guidelines for multidrug-resistant gonococcal urethritis, the preferred treatment is:
- A Ceftriaxone 250 mg IM single dose
- B Spectinomycin 2 g IM single dose
- C Cefixime 400 mg oral single dose
- D Ceftriaxone 500 mg IM single dose (WHO 2016) or 500 mg IM + azithromycin 1 g oral if susceptibility unknown ✓
Explanation
Due to global emergence of extensively drug-resistant N. gonorrhoeae, WHO 2016 and updated guidelines recommend a single-dose regimen of ceftriaxone 500 mg IM (or 1 g IM in some settings with high resistance rates) as first-line monotherapy. When azithromycin susceptibility is unknown or in settings of dual resistance, ceftriaxone 500 mg IM + azithromycin 1 g oral (dual therapy) is recommended. Spectinomycin (2 g IM) is an alternative when ceftriaxone cannot be used. Oral cefixime and fluoroquinolones are no longer recommended due to resistance. Penicillin resistance is mediated by plasmid-encoded TEM-1 beta-lactamase (PPNG).
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.