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:* '''Neisseria gonorrhoeae, treatment'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
:* '''Neisseria gonorrhoeae, treatment'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
::* '''1. Gonococcal infections in adolescents and adults'''
::* 1. '''Gonococcal infections in adolescents and adults'''
:::* '''1.1 Uncomplicated gonococcal infections of the cervix, urethra, and rectum'''
:::* 1.1 '''Uncomplicated gonococcal infections of the cervix, urethra, and rectum'''
::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
::::* Alternative regimen: [[Cefixime]] 400 mg PO in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose (if ceftriaxone is not available)
::::* Alternative regimen: [[Cefixime]] 400 mg PO in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose (if ceftriaxone is not available)


:::* '''1.2 Uncomplicated gonococcal infections of the pharynx'''
:::* 1.2 '''Uncomplicated gonococcal infections of the pharynx'''
::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose


:::::* '''1.2.1 Management of sex partners'''
:::::* 1.2.1 '''Management of sex partners'''
::::::* Expedited partner therapy: [[Cefixime]] 400 mg PO in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
::::::* Expedited partner therapy: [[Cefixime]] 400 mg PO in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
::::::: Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or gonorrhea diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.  
::::::*Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or gonorrhea diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.  
::::::: Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.  
::::::*Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.  
::::::: Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present.
::::::* Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present.


:::::* '''1.2.2 Allergy, intolerance, and adverse reactions'''
:::::* 1.2.2 '''Allergy, intolerance, and adverse reactions'''
::::::* Preferred regimen (1): [[Gemifloxacin]] 320 mg PO in a single dose {{and}} [[Azithromycin]] 2 g PO in a single dose
::::::* Preferred regimen (1): [[Gemifloxacin]] 320 mg PO in a single dose {{and}} [[Azithromycin]] 2 g PO in a single dose
::::::* Preferred regimen (2): [[Gentamicin]] 240 mg IM in a single dose {{and}} [[Azithromycin]] 2 g PO in a single dose
::::::* Preferred regimen (2): [[Gentamicin]] 240 mg IM in a single dose {{and}} [[Azithromycin]] 2 g PO in a single dose
::::::: Note: Use of ceftriaxone or cefixime is contraindicated in persons with a history of an IgE-mediated penicillin allergy (e.g., anaphylaxis, Stevens Johnson syndrome, and toxic epidermal necrolysis).
::::::* Note: Use of ceftriaxone or cefixime is contraindicated in persons with a history of an IgE-mediated penicillin allergy (e.g., anaphylaxis, Stevens Johnson syndrome, and toxic epidermal necrolysis).


:::::* '''1.2.3 Pregnancy'''
:::::* '''1.2.3 Pregnancy'''
::::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
::::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose


:::::* '''1.2.4 Suspected cephalosporin treatment failure'''
:::::* 1.2.4 '''Suspected cephalosporin treatment failure'''
::::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
::::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
::::::* Alternative regimen (1): [[Gemifloxacin]] 320 mg PO  single dose  {{and}} [[Azithromycin]] 2 g PO  single dose (when isolates have elevated cephalosporin MICs)
::::::* Alternative regimen (1): [[Gemifloxacin]] 320 mg PO  single dose  {{and}} [[Azithromycin]] 2 g PO  single dose (when isolates have elevated cephalosporin MICs)
::::::* Alternative regimen (2): [[Gentamicin]] 240 mg IM  single dose {{and}} [[Azithromycin]] 2 g PO single dose (when isolates have elevated cephalosporin MICs)
::::::* Alternative regimen (2): [[Gentamicin]] 240 mg IM  single dose {{and}} [[Azithromycin]] 2 g PO single dose (when isolates have elevated cephalosporin MICs)
::::::* Alternative regimen (3): [[Ceftriaxone]] 250 mg IM as a single dose {{and}} [[Azithromycin]] 2 g PO as a single dose (failure after treatment with cefixime and azithromycin)
::::::* Alternative regimen (3): [[Ceftriaxone]] 250 mg IM as a single dose {{and}} [[Azithromycin]] 2 g PO as a single dose (failure after treatment with cefixime and azithromycin)
::::::: Note: Treatment failure should be considered in: (1) persons whose symptoms do not resolve within 3–5 days after appropriate treatment and report no sexual contact during the post-treatment follow-up period; (2) persons with a positive test-of-cure (i.e., positive culture ≥ 72 hours or positive NAAT ≥ 7 days after receiving recommended treatment) when no sexual contact is reported during the post-treatment follow-up period; (3) persons who have a positive culture on test-of-cure (if obtained) if there is evidence of decreased susceptibility to cephalosporins on antimicrobial susceptibility testing, regardless of whether sexual contact is reported during the post-treatment follow-up period.
::::::* Note: Treatment failure should be considered in: (1) persons whose symptoms do not resolve within 3–5 days after appropriate treatment and report no sexual contact during the post-treatment follow-up period; (2) persons with a positive test-of-cure (i.e., positive culture ≥ 72 hours or positive NAAT ≥ 7 days after receiving recommended treatment) when no sexual contact is reported during the post-treatment follow-up period; (3) persons who have a positive culture on test-of-cure (if obtained) if there is evidence of decreased susceptibility to cephalosporins on antimicrobial susceptibility testing, regardless of whether sexual contact is reported during the post-treatment follow-up period.


:::* '''1.3 Gonococcal conjunctivitis'''
:::* 1.3 '''Gonococcal conjunctivitis'''
::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
::::: Note: Consider one-time lavage of the infected eye with saline solution.
::::: Note: Consider one-time lavage of the infected eye with saline solution.


:::::* '''1.3.1 Management of sex partners'''
:::::* 1.3.1 '''Management of sex partners'''
::::::* Patients should be instructed to refer their sex partners for evaluation and treatment.  
::::::* Patients should be instructed to refer their sex partners for evaluation and treatment.  


:::* '''1.4 Disseminated gonococcal infection'''   
:::* 1.4 '''Disseminated gonococcal infection'''   
:::::* '''1.4.1 Arthritis and arthritis-dermatitis syndrome '''
:::::* 1.4.1 ''''Arthritis and arthritis-dermatitis syndrome '''
::::::* Preferred regimen: [[Ceftriaxone]] 1 g IM/IV q24h for 7 days {{and}} [[Azithromycin]] 1 g PO in a single dose
::::::* Preferred regimen: [[Ceftriaxone]] 1 g IM/IV q24h for 7 days {{and}} [[Azithromycin]] 1 g PO in a single dose
::::::* Alternative regimen: [[Cefotaxime]] 1 g IV q8h for 7 days {{or}} [[Ceftizoxime]] 1 g IV q 8 h  for 7 days {{and}} [[Azithromycin]] 1 g PO in a single dose
::::::* Alternative regimen: [[Cefotaxime]] 1 g IV q8h for 7 days {{or}} [[Ceftizoxime]] 1 g IV q 8 h  for 7 days {{and}} [[Azithromycin]] 1 g PO in a single dose


:::::* '''1.4.2 Gonococcal meningitis and endocarditis'''
:::::* 1.4.2 ''''Gonococcal meningitis and endocarditis'''
::::::* Preferred regimen : [[Ceftriaxone]] 1-2 g IV  q 12-24 h  for 10-14 days {{and}} [[Azithromycin]] 1 g PO in a single dose
::::::* Preferred regimen : [[Ceftriaxone]] 1-2 g IV  q 12-24 h  for 10-14 days {{and}} [[Azithromycin]] 1 g PO in a single dose


::* '''2. Gonococcal infections among neonates'''
::* 2. ''''Gonococcal infections among neonates'''
:::* '''2.1 Ophthalmia neonatorum caused by N. gonorrhoeae'''
:::* 2.1 ''''Ophthalmia neonatorum caused by N. gonorrhoeae'''
::::* Preferred regimen: [[Ceftriaxone]] 25-50 mg/kg IV or IM in a single dose, not to exceed 125 mg
::::* Preferred regimen: [[Ceftriaxone]] 25-50 mg/kg IV or IM in a single dose, not to exceed 125 mg


Revision as of 14:43, 15 July 2015

  • 1 Chlaymydial infections [1]
  • 1.1 Chlamydial Infections in Adolescents and Adults
  • Preferred regimen(1): Doxycycline 100 mg PO bid for 7 days
  • Preferred regimen(2): Azithromycin 1 g PO in a single dose
  • Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
  • Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
  • Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
  • Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days.
  • Note: Patients should be instructed to refer their sex partners for evaluation, testing, and treatment if they had sexual contact with the patient during the 60 days preceding onset of the patient's symptoms or chlamydia diagnosis.
  • 1.2 Chlamydial Infections in patients with HIV Infection
  • Preferred regimen(1): Doxycycline 100 mg PO bid for 7 days
  • Preferred regimen(2): Azithromycin 1 g PO in a single dose
  • Preferred regimen(3): Azithromycin 1 g PO in a single dose
  • Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
  • Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
  • Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
  • Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days.
  • 1.3 Pregancy
  • 1.4 Management of sex partners
  • Preferred regimen (1): Doxycycline 100 mg PO bid for 7 days
  • Preferred regimen (2): Azithromycin 1 g PO in a single dose
  • Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
  • Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
  • Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
  • Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days.
  • Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or Chlamydia diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
  • Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
  • Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present
  • 2 Chlamydial infection among neonates
  • 2.1 Ophthalmia Neonatorumcaused by C. trachomatis
  • Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/ day divided into 4 doses PO daily for 14 days
  • Alternative regimen: Azithromycin suspension 20 mg/kg /day PO qd for 3 days
  • Note: The mothers of infants who have chlamydial infection and the sex partners of these women should be evaluated and treated.
  • 2.2 Infant Pneumonia
  • Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/ day divided into 4 doses PO daily for 14 days
  • Alternative regimen: Azithromycin suspension 20 mg/kg /day PO qd for 3 days
  • 3.Chlamydial infection among infants and childern
  • 3.1 Infants and childern who weigh < 45 kg
  • Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/ day divided into 4 doses PO daily for 14 days
  • 3.2 Infants and childern who weigh ≥45 kg but who are aged <8 years
  • 3.3 Infants and childern aged ≥8 years
  • Preferred regimen(1): Azithromycin 1 g PO in a single dose
  • Preferred regimen(2): Doxycycline 100 mg PO bid for 7 days
  • 4. Lymphogranuloma venereum (LGV)
  • Lymphogranuloma venereum (LGV) is caused by C. trachomatis serovars L1, L2, or L3 '[2]
  • Preferred regimen: Doxycycline 100 mg PO bid for 21 days
  • Alternative regimen: Erythromycin base 500 mg PO qid for 21 days
  • Note (1): Azithromycin 1 g PO once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.
  • Note (2): Pregnant and lactating women should be treated with Erythromycin. Azithromycin might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. Doxycycline is contraindicated in pregnant women.
  • Note (3): Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.
  • Note(4): Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined and tested for urethral, cervical, or rectal chlamydial infection depending on anatomic site of exposure. They should be presumptively treated with a chlamydia regimen ( Azithromycin 1 g PO single dose OR Doxycycline 100 mg PO bid for 7 days).


  • Neisseria gonorrhoeae, treatment[3]
  • 1. Gonococcal infections in adolescents and adults
  • 1.1 Uncomplicated gonococcal infections of the cervix, urethra, and rectum
  • Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
  • Alternative regimen: Cefixime 400 mg PO in a single dose AND Azithromycin 1 g PO in a single dose (if ceftriaxone is not available)
  • 1.2 Uncomplicated gonococcal infections of the pharynx
  • 1.2.1 Management of sex partners
  • Expedited partner therapy: Cefixime 400 mg PO in a single dose AND Azithromycin 1 g PO in a single dose
  • Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or gonorrhea diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
  • Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
  • Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present.
  • 1.2.2 Allergy, intolerance, and adverse reactions
  • Preferred regimen (1): Gemifloxacin 320 mg PO in a single dose AND Azithromycin 2 g PO in a single dose
  • Preferred regimen (2): Gentamicin 240 mg IM in a single dose AND Azithromycin 2 g PO in a single dose
  • Note: Use of ceftriaxone or cefixime is contraindicated in persons with a history of an IgE-mediated penicillin allergy (e.g., anaphylaxis, Stevens Johnson syndrome, and toxic epidermal necrolysis).
  • 1.2.3 Pregnancy
  • 1.2.4 Suspected cephalosporin treatment failure
  • Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
  • Alternative regimen (1): Gemifloxacin 320 mg PO single dose AND Azithromycin 2 g PO single dose (when isolates have elevated cephalosporin MICs)
  • Alternative regimen (2): Gentamicin 240 mg IM single dose AND Azithromycin 2 g PO single dose (when isolates have elevated cephalosporin MICs)
  • Alternative regimen (3): Ceftriaxone 250 mg IM as a single dose AND Azithromycin 2 g PO as a single dose (failure after treatment with cefixime and azithromycin)
  • Note: Treatment failure should be considered in: (1) persons whose symptoms do not resolve within 3–5 days after appropriate treatment and report no sexual contact during the post-treatment follow-up period; (2) persons with a positive test-of-cure (i.e., positive culture ≥ 72 hours or positive NAAT ≥ 7 days after receiving recommended treatment) when no sexual contact is reported during the post-treatment follow-up period; (3) persons who have a positive culture on test-of-cure (if obtained) if there is evidence of decreased susceptibility to cephalosporins on antimicrobial susceptibility testing, regardless of whether sexual contact is reported during the post-treatment follow-up period.
  • 1.3 Gonococcal conjunctivitis
Note: Consider one-time lavage of the infected eye with saline solution.
  • 1.3.1 Management of sex partners
  • Patients should be instructed to refer their sex partners for evaluation and treatment.
  • 1.4 Disseminated gonococcal infection
  • 1.4.1 'Arthritis and arthritis-dermatitis syndrome
  • 1.4.2 'Gonococcal meningitis and endocarditis
  • 2. 'Gonococcal infections among neonates
  • 2.1 'Ophthalmia neonatorum caused by N. gonorrhoeae
  • Preferred regimen: Ceftriaxone 25-50 mg/kg IV or IM in a single dose, not to exceed 125 mg
  • 2.1.1 Management of mothers and their sex partners
  • Mothers of infants with ophthalmia neonatorum caused by N. gonorrhoeae should be evaluated, tested, and presumptively treated for gonorrhea, along with their sex partner(s).
  • 2.2 Disseminated gonococcal infection and gonococcal scalp abscesses in neonates
  • Preferred regimen: Ceftriaxone 25-50 mg/kg/day IM/IV qd for 7 days OR Cefotaxime 25 mg/kg IV /IM q12h for 7 days.
Note (1): The duration of treatment is 10-14 days if meningitis is documented.
Note (2): Ceftriaxone should be administered cautiously to hyperbilirubinemic infants, especially those born prematurely.
  • 2.2.1 Management of mothers and their sex partners
  • Mothers of infants who have DGI or scalp abscesses caused by N. gonorrhoeae should be evaluated, tested, and presumptively treated for gonorrhea, along with their sex partner(s).
  • 2.3 Neonates born to mothers who have gonococcal infection
  • Preferred regimen: Ceftriaxone 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg
  • 2.3.1 Management of mothers and their sex partners
  • Mothers who have gonorrhea and their sex partners should be evaluated, tested, and presumptively treated for gonorrhea.
  • 3. Gonococcal infections among infants and children
  • 3.1 Infants and children who weigh ≤ 45 kg and who have uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis
  • Preferred regimen: Ceftriaxone 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg
  • 3.2 Children who weigh > 45 kg and who have uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis
  • Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1g PO in a single dose
  • Alternative regimen: Cefixime 400 mg PO single dose AND Azithromycin 1 g PO single dose.(If ceftriaxone is not available)
  • 3.3 Children who weigh ≤ 45 kg and who have bacteremia or arthritis
  • Preferred regimen: Ceftriaxone 50 mg/kg (maximum dose: 1 g) IM/IV q24h for 7 days
  • 3.4 Children who weigh > 45 kg and who have bacteremia or arthritis
  • Preferred regimen: Ceftriaxone 1 g IM/IV q24h for 7 days



  • Klebsiella granulomatis (formly known as Calymmatobacterium granulomatis)
  • Granuloma inguinale (donovanosis)[4]
  • Preferred regimen: Azithromycin 1 g PO once a week or 500 mg qd for 3 weeks and until all lesions have completely healed
  • Alternative regimen (1): Doxycycline 100 mg PO bid for 3 weeks and until all lesions have completely healed
  • Alternative regimen (2): Ciprofloxacin 750 mg PO bid for at least 3 weeks and until all lesions have completely healed
  • Alternative regimen (3): Erythromycin base 500 mg PO qid for at least 3 weeks and until all lesions have completely healed
  • Alternative regimen (4): Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet PO bid for at least 3 weeks and until all lesions have completely healed


  • 1. Pneumonia[5]
  • 1.1 Adult
  • 1.2 Pediatric
  • Preferred regimen: Azithromycin
  • Alternative regimen: fluoroquinolones
  • 1.3 Pregnant Patients
  • Preferred regimen: Azithromycin
  • Alternative regimen: fluoroquinolones
  • 2.Endocarditis in valve replacement patients
  • Preferred regimen: Doxycycline
  • Alternative regimen: fluoroquinolones.



  • Atypical bacterial pneumonia caused by Legionella [6]
  • Atypical pneumonia caused by Mycoplasma pneumoniae[7]
  • Preferred regimen (1): Azithromycin 500 mg PO day 1 and 250 mg day 2 to 5
  • Preferred regimen (2): Doxycycline 100 mg PO bid for 14 days
  • Preferred regimen (3): Moxifloxacin 400 mg PO qd for 14 days
  • 1. Urethritis and cervicitis[8]
  • Preferred regimen (macrolide-susceptible strains) (1): Azithromycin 1 g PO as a single dose
  • Preferred regimen (macrolide-susceptible strains) (2): Azithromycin 500 mg PO as a dose followed by 250 mg PO qd for 4 days
  • Preferred regimen (for patients with previous treatment failures): Moxifloxacin 400 mg PO qd for 7–14 days
  • 2. Pelvic inflammatory disease (PID)[9]
  • 3. Specific considerations[10]
  • 3.1 Management of sex partners
  • Sex partners should be managed according to guidelines for patients with nongonococcal urethritis, cervicitis, and pelvic inflammatory disease.
  • 3.2 HIV infection
  • Persons who have an M. genitalium infection and HIV infection should receive the same treatment regimen as those who are HIV negative.


===

  • 1.1 Treatment of uncomplicated P. falciparum malaria
  • 1.1.1 Treat children and adults with uncomplicated P. falciparum malaria (except pregnant women in their first trimester) with one of the following recommended ACT (artemisinin-based combination therapy)
  • Preferred regimen (1): Artemether 5–24 mg/kg bw PO AND Lumefantrine 29–144 mg/ kg bw PO, Both are given bid for 3 days (total, six doses). The first two doses should, ideally, be given 8 h apart.
  • Preferred regimen (2): Artesunate (2–10) mg/kg bw per day AND Amodiaquine(7.5–15) mg/kg bw per day ,both are given once a day for 3 days. A total therapeutic dose range of 6–30 mg/kg bw per day artesunate and 22.5–45 mg/kg bw per dose amodiaquine is recommended
  • Preferred regimen (3): Artesunate (2–10) mg/kg bw per dayAND Mefloquine (2–10) mg/kg bw per day both are given once a day for 3 days
  • Dosage regimen based on Body weight (kg)
  • Body weight (kg)-5 to < 9- Artesunate 25 (mg) AND Mefloquine 55 (mg) given bid for 3 days;
  • Body weight (kg)-9to < 18- Artesunate 50 (mg) AND Mefloquine 110 (mg) given bid for 3 days;
  • Body weight (kg)-18 to < 36- Artesunate 100 (mg) AND Mefloquine 220 (mg) given bid for 3 days;
  • Body weight (kg)- ≥ 36 - Artesunate 200 (mg) AND Mefloquine 440 (mg) given bid for 3 days;
  • Preferred regimen (4): Artesunate (2–10) mg/kg bw per day given once a day for 3 days AND Sulfadoxine-Pyrimethamine 1.25 (25–70 / 1.25–3.5) mg/kg bw given as a single dose on day 1
  • 1.1.2 Reducing the transmissibility of treated P. falciparum infections In low-transmission areas in patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months)
  • Preferred regimen: single dose of 0.25 mg/kg bw Primaquine with ACT
  • 1.2 Recurrent Falciparum Malaria
  • 1.2.1 Failure within 28 days
  • Note:The recommended second-line treatment is an alternative ACT known to be effective in the region. Adherence to 7-day treatment regimens (with artesunate or quinine both of which should be co-administered with + tetracycline, or doxycycline or clindamycin) is likely to be poor if treatment is not directly observed; these regimens are no longer generally recommended.
  • 1.2.2 Failure after 28 days
  • Note: all presumed treatment failures after 4 weeks of initial treatment should, from an operational standpoint, be considered new infections and be treated with the first-line ACT. However, reuse of mefloquine within 60 days of first treatment is associated with an increased risk for neuropsychiatric reactions, and an alternative ACT should be used
  • 1.3 Reducing the transmissibility of treated P. falciparum infections In low-transmission areas in patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months)
  • Note: a single dose of 0.25 mg/kg bw Primaquine with ACT
  • 1.4 Treating uncomplicated P. falciparum malaria in special risk groups
  • 1.4.1 Pregnancy
  • First trimester of pregnancy :Quinine AND Clindamycin 10mg/kg bw PO bid for 7 days
  • Second and third trimesters : Mefloquine is considered safe for the treatment of malaria during the second and third trimesters; however, it should be given only in combination with an artemisinin derivative.
  • Note(1): Quinine is associated with an increased risk for hypoglycaemia in late pregnancy, and it should be used (with clindamycin) only if effective alternatives are not available.
  • Note(2): Primaquine and tetracyclines should not be used in pregnancy.
  • 1.4.2 Infants less than 5kg body weight : with an ACT at the same mg/kg bw target dose as for children weighing 5 kg.
  • 1.4.3 Patients co-infected with HIV: should avoid Artesunate + SP if they are also receiving Co-trimoxazole, and avoid Artesunate AND Amodiaquine if they are also receiving efavirenz or zidovudine.
  • 1.4.4 Large and Obese adults: For obese patients, less drug is often distributed to fat than to other tissues; therefore, they should be dosed on the basis of an estimate of lean body weight, ideal body weight. Patients who are heavy but not obese require the same mg/kg bw doses as lighter patients.
  • 1.4.5 Patients co-infected with TB: Rifamycins, in particular rifampicin, are potent CYP3A4 inducers with weak antimalarial activity. Concomitant administration of rifampicin during quinine treatment of adults with malaria was associated with a significant decrease in exposure to quinine and a five-fold higher recrudescence rate
  • 1.4.6 Non-immune travellers : Treat travellers with uncomplicated P. falciparum malaria returning to nonendemic settings with an ACT.
  • 1.4.7 Uncomplicated hyperparasitaemia: People with P. falciparum hyperparasitaemia are at increased risk of treatment failure, severe malaria and death so should be closely monitored, in addition to receiving an ACT
  • 2. Treatment of uncomplicated malaria caused by P. vivax, P. ovale, P. malariae or P. knowlesi
  • 2.1 Blood Stage infection
  • 2.1.1. Uncomplicated malaria caused by P. vivax
  • 2.1.1.1 In areas with chloroquine-sensitive P. vivax
  • Preferred regimen: Chloroquine total dose of 25 mg base/kg bw PO. Chloroquine is given at an initial dose of 10 mg base/kg bw, followed by 10 mg/kg bw on the second day and 5 mg/kg bw on the third day.
  • 2.1.1.2 In areas with chloroquine-resistant P. vivax
  • 2.1.2 Uncomplicated malaria caused by P. ovale, P. malariae or P. knowlesi malaria
  • Note: Resistance of P. ovale, P. malariae and P. knowlesi to antimalarial drugs is not well characterized, and infections caused by these three species are generally considered to be sensitive to chloroquine. In only one study, conducted in Indonesia, was resistance to chloroquine reported in P. malariae. The blood stages of P. ovale, P. malariae and P. knowlesi should therefore be treated with the standard regimen of ACT or Chloroquine, as for vivax malaria.
  • 2.1.3 Mixed malaria infections
  • Note: ACTs are effective against all malaria species and so are the treatment of choice for mixed infections.
  • 2.2 Liver stages (hypnozoites) of P. vivax and P. ovale
  • Note: To prevent relapse, treat P. vivax or P. ovale malaria in children and adults (except pregnant women, infants aged < 6 months, women breastfeeding infants < 6 months, women breastfeeding older infants unless they are known not to be G6PD deficient and people with G6PD deficiency) with a 14-day course of primaquine in all transmission settings. Strong recommendation, high-quality evidence In people with G6PD deficiency, consider preventing relapse by giving primaquine base at 0.75 mg base/kg bw once a week for 8 weeks, with close medical supervision for potential primaquine-induced adverse haematological effects.]
  • 2.2.1 Primaquine for preventive relapse
  • Preferred regimen: Primaquine 0.25–0.5 mg/kg bw per day PO qd for 14 days
  • 2.2.2 Primaquine and glucose-6-phosphate dehydrogenase deficiency
  • Preferred regimen:Primaquine 0.75 mg base/kg bw PO once a week for 8 weeks.
  • Note: The decision to give or withhold Primaquine should depend on the possibility of giving the treatment under close medical supervision, with ready access to health facilities with blood transfusion services.
  • 2.2.3 Prevention of relapse in pregnant or lacating women and infants
  • Note: Primaquine is contraindicated in pregnant women, infants < 6months of age and in lactating women (unless the infant is known not to be G6PD deficient).
  • 3.Treatment of severe malaria
  • 3.1 Treatment of severe falciparum infection with Artesunate
  • 3.1.1 Adults and children with severe malaria (including infants, pregnant women in all trimesters and lactating women):-
  • Preferred regimen: Artesunate IV/IM for at least 24 h and until they can tolerate oral medication. Once a patient has received at least 24 h of parenteral therapy and can tolerate oraltherapy, complete treatment with 3 days of an ACT (add single dose Primaquine in areas of low transmission).
  • 3.1.2 Young children weighing < 20 kg
  • Preferred regimen:Artesunate (3 mg/kg bw per dose)
  • Alternatives regimen: use Artemether in preference to quinine for treating children and adults with severe malaria
  • 3.2.Treating cases of suspected severe malaria pending transfer to a higher-level facility (pre-referral treatment)
  • 3.2.1 Adults and children
  • 3.2.2 Children < 6 years
  • Preferred regimen: Where intramuscular injections of artesunate are not available , treat with a single rectal dose (10 mg/kg bw) of Artesunate, and refer immediately to an appropriate facility for further care.
  • Note: Do not use rectal artesunate in older children and adults.
  • 3.3 Pregancy
  • Note: Parenteral artesunate is the treatment of choice in all trimesters. Treatment must not be delayed
  • 3.4 Treatment of severe P.Vivax infection
  • Note: parenteral artesunate, treatment can be completed with a full treatment course of oral ACT or chloroquine (in countries where chloroquine is the treatment of choice). A full course of radical treatment with primaquine should be given after recovery
  • 3.5 Additional aspects of management in severe malaria
  • Fluid therapy: It is not possible to give general recommendations on fluid replacement; each patient must be assessed individually and fluid resuscitation based on the estimated deficit
  • Blood Transfusion :In high-transmission settings, blood transfusion is generally recommended for children with a haemoglobin level of < 5 g/100 mL(haematocrit < 15%). In low-transmission settings, a threshold of 20% (haemoglobin,7 g/100 mL) is recommended
  • Exchange blood transfusion: Exchange blood transfusion requires intensive nursing care and a relatively large volume of blood, and it carries significant risks. There is no consensus on the indications, benefits and dangers involved or on practical details such as the volume of blood that should be exchanged. It is, therefore, not possible to make any recommendation regarding the use of exchange blood transfusion.








  1. ↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
  2. ↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
  3. ↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
  4. ↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
  5. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  6. ↑ Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC; et al. (2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clin Infect Dis. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083.
  7. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  8. ↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
  9. ↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
  10. ↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
  11. ↑ "Guidelines for the treatment of malaria. Third edition April 2015" (PDF).
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