New guidelines in a 2010 report issued by the Centers for Disease Control and Prevention for the treatment of sexually transmitted diseases contain major updates to its 2006 report that could prove significant for the nation's pharmacies.
New guidelines in a 2010 report issued by the Centers for Disease Control and Prevention (CDC) for the treatment of sexually transmitted diseases (STDs) contain major updates to its 20006 report that could prove significant for the nation's pharmacies.
N. gonorrhoeae resistance
The CDC guidelines note that quinolone-resistant Neisseria gonorrhoeae is now widely disseminated in the United States and the world. Consequently, the guidelines recommend that quinolones no longer be used for the treatment of gonorrhea and associated conditions such as pelvic inflammatory disease. The CDC guidelines emphasize that cephalosporins are the only class of antimicrobials recommended and available for treatment of gonorrhea in the United States.
In its report, "Sexually Transmitted Diseases Treatment Guidelines, 2010," CDC recommends ceftriaxone 250 mg IM in a single dose for the treatment of uncomplicated gonococcal infections of the cervix, urethra, and rectum.
If this is not an option, CDC recommends cefixime 400 mg orally in a single dose or single-dose injectible cephalosporin regimens plus azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice a day for 7 days.
The recommendation for uncomplicated gonococcal infections of the pharynx is ceftriaxone 250 mg IM in a single dose plus azithromycin 1 g in a single dose or doxycycline 100 mg orally twice a day for 7 days.
Bacterial vaginosis and genital warts
The CDC recommends the following treatment for women showing symptoms of bacterial vaginosis: metronidazole 500 mg orally twice a day for 7 days or metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days, or clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days.
Alternative regimens for bacterial vaginosis recommended by the CDC include: tinidazole (either 2 g orally once daily for 2 days or 1 g orally daily for 5 days) or clindamycin (300 mg orally twice daily for 7 days, or clindamycin ovules 100 mg intravaginally once at bedtime for 3 days).
There is no clinical evidence that any one treatment is superior to another for the treatment of external genital warts. Therefore, treatment is guided by patient preference. The CDC recommends the following patient-applied treatments: podofilox 0.5% solution or gel, or imiquimod 5% cream.
The CDC also includes sinecatechins 15% ointment (Veregen) in the treatment of external genital warts. Veregen, derived from green tea leaves, was the first botanical drug to receive FDA approval for prescription use and the first to be included in CDC's STD Guidelines, said Rosen. Rosen praised the inclusion of Veregen in the CDC guidelines because it results in the lowest rate of recurrence - 6% to 7% - compared to rates for other treatments for external genital warts.
Rosen added that the best recurrence rates with a carbon dioxide laser light are 9% and the recurrence rates are about 20% for other popular medications.
"There are many botanical products that are considered safe and effective in other countries," adds Rosen. "We [in the United States] are just starting to realize their value."