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WHO GUIDELINES FOR THE
Treatment of Neisseria gonorrhoeae

[Texte complet]
2016

The following six recommendations apply to adults, adolescents (10-19 years of age), people living with HIV, and key populations, including sex workers, men who have sex with men (MSM) and transgender persons. Specific recommendations have also been developed for ophthalmia neonatorum caused by N. gonorrhoeae

Voir également :IST - MST : recommandation 2016 de la SFD (Info-antibio N°65: Mars 2016) [Lire]

RECOMMENDATION 1 : GENITAL AND ANORECTAL GONOCOCCAL INFECTIONS
The WHO STI guideline recommends that local resistance data should determine the choice of therapy (both for dual therapy and single therapy). Good practice statement
In settings where local resistance data are not available, the WHO STI guideline suggests dual therapy over single therapy for people with genital or anorectal gonorrhoea.
Conditional recommendation, low quality evidence

The WHO STI guideline suggests the following options: Dual therapy (one of the following)
  • • ceftriaxone 250 mg intramuscular (IM) as a single dose PLUS azithromycin 1 g orally as a single dose
  • • cefixime 400 mg orally as a single dose PLUS azithromycin 1 g orally as a single dose

    Single therapy (one of the following, based on recent local resistance data confirming susceptibility to the antimicrobial)
  • • ceftriaxone 250 mg IM as a single dose
  • • cefixime 400 mg orally as a single dose
  • • spectinomycin 2 g IM as a single dose.

    RECOMMENDATION 2 : OROPHARYNGEAL GONOCOCCAL INFECTIONS
    In adults and adolescents with gonococcal oropharyngeal infections, the WHO STI guideline suggests dual therapy over single therapy. Conditional recommendation, very low quality evidence The WHO STI guideline suggests the following options: Dual therapy (one of the following) • ceftriaxone 250 mg IM as a single dose PLUS azithromycin 1 g orally as a single dose • cefixime 400 mg orally as a single dose PLUS azithromycin 1 g orally as a single dose Single therapy (based on recent local resistance data confirming susceptibility to the antimicrobial) • ceftriaxone 250 mg IM as single dose.

    RECOMMENDATION 3 : RETREATMENT OF GONOCOCCAL INFECTIONS AFTER TREATMENT FAILURE
    In people with gonococcal infections who have failed treatment, the WHO STI guideline suggests the following options. • If reinfection is suspected, re-treat with a WHOrecommended regimen, reinforce sexual abstinence or condom use, and provide partner treatment. • If treatment failure occurred after treatment with a regimen not recommended by WHO, re-treat with a WHO-recommended regimen.
    • If treatment failure occurred and resistance data are available, re-treat according to susceptibility.
    • If treatment failure occurred after treatment with a WHO-recommended single therapy, re-treat with WHO-recommended dual therapy.
    • If treatment failure occurred after a WHOrecommended dual therapy, re-treat with one of the following dual therapies:
    ---- ceftriaxone 500 mg IM as a single dose PLUS azithromycin 2 g orally as a single dose
    ---- cefixime 800 mg orally as a single dose PLUS azithromycin 2 g orally as a single dose
    ---- gentamicin 240 mg IM as a single dose PLUS azithromycin 2 g orally as a single dose
    ---- spectinomycin 2 g IM as a single dose (if not an oropharyngeal infection) PLUS azithromycin 2 g orally as a single dose.
    Conditional recommendation, very low quality evidence

    RECOMMENDATION 4 : OPHTHALMIA NEONATORUM
    In neonates with gonococcal conjunctivitis, the WHO STI guideline suggests one of the following treatment options: ---- ceftriaxone 50 mg/kg (maximum 150 mg) IM as a single dose
    ---- kanamycin 25 mg /kg (maximum 75 mg) IM as a single dose
    ---- spectinomycin 25 mg/kg (maximum 75 mg) IM as a single dose.
    Conditional recommendation, very low quality evidence

    RECOMMENDATION 5 For all neonates,
    the WHO STI guideline recommends topical ocular prophylaxis for the prevention of gonococcal and chlamydial ophthalmia neonatorum.
    Strong recommendation, low quality evidence

    RECOMMENDATION 6 For ocular prophylaxis,
    the WHO STI guideline suggests one of the following options for topical application to both eyes immediately after birth: • tetracycline hydrochloride 1% eye ointment
    • erythromycin 0.5% eye ointment
    • povidone iodine 2.5% solution (water-based)
    • silver nitrate 1% solution
    • chloramphenicol 1% eye ointment.
    Conditional recommendation, low quality evidence

    Remarks: Recommendations 5 and 6 apply to the prevention of both chlamydial and gonococcal ophthalmia neonatorum. Cost and local resistance to erythromycin, tetracycline and chloramphenicol in gonococcal infection may determine the choice of medication. Caution should be taken to avoid touching eye tissue when applying the topical treatment and to provide a water-based solution of povidone iodine. Alcohol-based povidone iodine solution must not be applied. The topical application should be administered immediately after birth.
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