Neisseria gonorrhoeae is increasingly resistant to standard antibiotics. NACO/WHO currently recommends which first-line treatment for uncomplicated urogenital gonorrhoea given the high rates of fluoroquinolone resistance in India?
- A Ceftriaxone 500 mg IM single dose (or 1 g if weight ≥150 kg) ✓
- B Ciprofloxacin 500 mg single dose oral
- C Azithromycin 1 g single dose oral monotherapy
- D Spectinomycin 2 g IM single dose
Explanation
Due to widespread fluoroquinolone resistance (>90% in India and many Asian countries) and emerging azithromycin resistance, WHO 2016 and updated 2022 guidelines recommend ceftriaxone as the only reliably effective monotherapy for gonorrhoea. The updated WHO recommendation (2022) is ceftriaxone 500 mg IM single dose (increased from previous 250 mg recommendation due to rising MIC levels). Ciprofloxacin is no longer recommended due to high resistance. Azithromycin is no longer recommended as monotherapy; dual therapy was previously used but azithromycin has been dropped due to resistance. Spectinomycin is effective but limited availability.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
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