Treatment of gonococcal conjunctivitis in adults

Gonococcal conjunctivitis requires systemic treatment; topical antimicrobial therapy is not adequate.

For adults, while awaiting ophthalmology review, as a 2-drug regimen, useOng, 2023:

ceftriaxone 1 g intramuscularly¹ or intravenously, as a single dose ceftriaxone ceftriaxone ceftriaxone

PLUS

azithromycin 1 g orally, as a single dose. azithromycin azithromycin azithromycin

Azithromycin is used in combination with ceftriaxone to treat possible coinfection with Chlamydia trachomatis and to delay cephalosporin resistance in N. gonorrhoeae.

For adults who have had a nonsevere (immediate or delayed) or a severe immediate² hypersensitivity reaction to a penicillin, while awaiting ophthalmology review, use the regimen above.

For adults who have had a severe delayed³ hypersensitivity reaction to a penicillin, seek expert advice.

Irrigate the eye with saline several times daily until purulence subsides. Immediately refer to an ophthalmologist if corneal opacity develops.

Evaluate the patient for other sites of infection, as well as other sexually transmissible infections (STIs). See Approach to Neisseria gonorrhoeae infection for information on additional testing (including test of cure) and contact tracing.

¹ Intramuscular injection of ceftriaxone is painful; consider reconstituting with lidocaine 1%.Return

² Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return

³ Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return