Gonorrhea treatment in BC
In 2012, treatment guidelines for gonorrhea evolved and recommendations for GC treatment in BC now are:
First line treatment
Cefixime 800 mg PO for one dose AND
Either Azithromycin 1 gram x for one dose or Doxycycline 100 mg po BID for 7 days
Ceftriaxone 250 mg IM (coupled with lidocaine 1% as the standard diluent) for one dose AND
Either Azithromycin 1 gram PO for one dose or Doxycycline 100 mg PO BID for 7 days
Second line treatments
Azithromycin 2 grams PO in a single dose (a regular formulary item)
Spectinomycin 2 grams IM in a single dose (accessible only through case management via Health Canada’s Special Access Programme)
(see also http://www.bccdc.ca/dis-cond/comm-manual/CDManualChap5.htm)
Cefixime (Suprax®) is supplied by Sanofi but is manufactured by a global-affiliated plant. Quality assurance issues were raised by regulators and this resulted in the suspension of the production line which manufactures Suprax® and other products.
Initially, in May 2014, it was felt that the manufacturing would resume relatively quickly and that Suprax® was expected to be nationally shorted through until December 2014. This shortage has now been extended to September 2015.
The Public Health Agency of Canada and the Health Authorities are exploring alternate sources, but in all likelihood, the current BCCDC supply of Suprax will be limited before manufacturing recommences.
During this shortage, there will be limited supplies of cefixime. BC treatment guidelines will remain unchanged.
Practitioners are strongly encouraged to use the first line therapy available:
- Ceftriaxone 250 mg IM (coupled with lidocaine 1% as the standard diluent) for one dose, with either Azithromycin 1 g PO for one dose OR Doxycycline 100 mg PO BID for 7 days) for all cases and contacts of GC.
In cases when an IM treatment is not acceptable, second line treatment (Azithromycin 2 grams PO in a single dose) can be used if indicated.
For more information
To access cefixime during this shortage, or if you have any questions, please call the Provincial STI Clinic at the BC Centre for Disease Control at 604-707-5600.