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Old 06-30-2012
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Bacteria GC and penicillin allergy !

what is treatment of GC in patient with penicillin anaphylaxis history ?

Spectinomycin for GC is used only in pregnant patients ! so is answer desensitization ?
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Old 07-01-2012
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Uncomplicated Gonococcal Infections of the Cervix, Urethra, and Rectum

Recommended Regimens

Ceftriaxone 250 mg IM in a single dose

OR, IF NOT AN OPTION

Cefixime 400 mg orally in a single dose

OR

Single-dose injectible cephalosporin regimens

PLUS

Azithromycin 1g orally in a single dose

OR

Doxycycline 100 mg orally twice a day for 7 days

Quote:
Spectinomycin, which is useful in persons who cannot tolerate cephalosporins, is expensive, must be injected, and is not available in the United States (updates available at: www.cdc.gov/std/treatment) (310). However, it has been effective in published clinical trials, curing 98.2% of uncomplicated urogenital and anorectal gonococcal infections. Spectinomycin has poor efficacy against pharyngeal infection (51.8%; 95% CI = 38.7%–64.9%) (306).
Pregnancy
Quote:
As with other patients, pregnant women infected with N. gonorrhoeae should be treated with a recommended or alternate cephalosporin. Because spectinomycin is not available in the United States, azithromycin 2 g orally can be considered for women who cannot tolerate a cephalosporin. Either azithromycin or amoxicillin is recommended for treatment of presumptive or diagnosed C. trachomatis infection during pregnancy
Quote:
No proven alternatives to penicillin are available for treating neurosyphilis, congenital syphilis, or syphilis in pregnant women. Penicillin also is recommended for use, whenever possible, in HIV-infected patients.
Quote:
PENICILLIN DESENSITIZATION

Desensitization can be done for people who are truly allergic to penicillin, but require treatment with it or a closely related antibiotic. Desensitization refers to a process of giving a medication in a controlled and gradual manner, which allows the person to tolerate it temporarily without an allergic reaction.

Technique — Desensitization can be performed with oral or intravenous medications, but should always be performed by an allergy specialist. There are different techniques for desensitization. Some patients undergo desensitization in an outpatient clinic under supervision while others are treated in an intensive care unit.

Limitations — While usually successful, desensitization has two important limitations.

Desensitization does not work and must never be attempted for certain types of reactions (such as Stevens-Johnson syndrome, toxic epidermal necrolysis, erythroderma, erythema multiforme, and some others). Desensitization also does not work for other types of immunologic reactions to antibiotics, such as serum sickness, drug fever, or hemolytic anemia.

Desensitization is temporary. A person is unlikely to have an allergic reaction to the medication during treatment, after undergoing desensitization, as long as the antibiotic is taken regularly. However, once the antibiotic is stopped for more than 24 hours (times differ slightly for different medications), the person is again at risk for a sudden allergic reaction. Repeat desensitization is required if the same medication is needed again.

Last edited by Novobiocin; 07-01-2012 at 07:10 AM.
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Old 07-01-2012
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so doxy wud be ans in history of pencillin anaphylaxis ?
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Old 07-01-2012
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Originally Posted by tyagee View Post
so doxy wud be ans in history of pencillin anaphylaxis ?
Yes, since I do not see Spectinomycin in the recommendations from CDC.

Looks like Spectinomycin is the most common wrong answer.
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Old 05-09-2014
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Management of gonorrhea (updated):

if symptomatic: preform gram stain of d/c
if gram stain positive with gram negative diplococci tx with ceftriaxone
if gram stain negative. preform nucleic acid amplicfication if suspcicion high.
If positive treat with ceftriaxone.
if negative consider alternate dx

Drug of choice is cephlosporin (ceftriaxone)but if allergy history:
best next step is to preform skin test
if positive treat with macrolide instead.
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