Wednesday, December 30, 2020

Paediatric & Adult Dosages of Antibiotics for Prophylaxis of Sexually Transmitted Diseases (STD)


 

Ceftriaxone

Azithromycin (PO)

Metronidazole (PO)

BNFC

v3.0.6 (828)

Updated on 2 Dec 2020

Uncomplicated gonorrhea (by deep IM)

·       1 month – 12 years (<45 kg): 125 mg STAT

·       2-12 years (≥45 kg): 250 mg STAT

·       13-15 years: 500 mg STAT

·       Adult: 1 g STAT

 

*Neonatal congenital gonococcal conjunctivitis: IM Cefotaxime 100 mg/kg (max 1 g) STAT

 

Uncomplicated genital chlamydial infections / Non-gonococcal urethritis

12-17 years or adult: 1 g STAT

 

Uncomplicated gonorrhea:

·       13-15 years: 1g STAT (in combination with other antibiotics) OR 2 g STAT (as monotherapy)

·       16-17 years or adult: 2 g STAT

Urogenital trichomoniasis:

·       1-2 years: 50 mg TDS for 7 days

·       3-6 years: 100 mg BD for 7 days

·       7-9 years: 100 mg TDS for 7 days

·       10-17 years or adult:

ü 200 mg TDS for 7 days OR

ü 400-500 mg BD for 5-7 days OR

ü 2 g STAT

 

Lexicomp

v5.9.2

Gonococcal infections

IM/IV: Neonatal: 25-50 mg/kg STAT (max 125 mg/dose)

*Administer cautiously to hyperbilirubinemic neonates, esp those born premature; alternative agent may be necessary

 

Gonococcal infections, treatment – uncomplicated cervicitis, pharyngitis, proctitis, urethritis and vulvovaginitis:

·        Infants & children ≤ 45 kg: IM/IV: 25-50 mg/kg STAT; max 125 mg/dose

·        Children > 45 kg, adolescents & adult: IM 250 mg STAT with a single oral dose of azithromycin

 

Prophylaxis against STD following sexual assault: Adolescents and adult: IM: 250 mg STAT with a single dose of oral azithromycin and oral metronidazole

Chlamydia trachomatis infection:

Urogenital / anogenital or oropharyngeal infection:

Children < 8 years with BW ≥45 kg or Children ≥ 8 years / adolescents / adult:

PO 1 g STAT

 

Sexual victimization, prophylaxis:

Adolescents & adults: 1 g STAT in combination with ceftriaxone and metronidazole.

Prophylaxis against sexually transmitted diseases following sexual assault: Adolescents: Oral: 2 g STAT with azithromycin and ceftriaxone.

 

Trichomoniasis, treatment:

·        < 45 kg: 15 mg/kg TDS for 7 days; max daily dose is 2 g

 

·       ≥ 45 kg and adolescents: 500 mg BD for 7 days OR 2 g STAT

(Note: 7-day-course has been shown to be more effective in adult women)

 

·       Adult: 500 mg BD for 7 days (2 g STAT less preferred due to inferior efficacy)

 

Micromedex

v2.5b851

Uncomplicated gonorrhea:

≤ 45 kg : IV/IM 25-50 mg/kg STAT (max 125 mg/dose)

> 45 kg : IM 250 mg IM STAT plus PO Azithromycin 1g STAT

Adult : Same as > 45 kg

Chlamydia trachomatis infection (cervicitis or urethritis):

≥ 45 kg OR ≥ 8 years old : 1 g STAT

 

STD prophylaxis – victim of sexual aggression (Adult) :

PO 2 g STAT + IM Ceftriaxone 250 mg STAT + PO Azithromycin 1 g STAT

 

Trichomoniasis (Adult):

2 g STAT (preferred, esp when pregnant) + 500 mg BD for 7 days

UptoDate: Evaluation and management of adult and adolescent sexual assault victims (Updated 25.11.2019)

Gonorrhea treatment:

IM Ceftriaxone 250 mg STAT

Chlamydia treatment:

PO 1 g STAT

Trichomoniasis treatment:

PO 2 g STAT

 

Mollen CJ et al. Acute Sexual Assault. Pediatr Emer Care 2012;28: 584-593

Gonorrhea prevention:

< 45 kg: IM 125 mg STAT

≥ 45 kg: IM 250 mg STAT

 

Chlamydia prevention:

< 45 kg: PO 20 mg/kg (max 1 g) STAT

≥ 45 kg: PO 1 g STAT

 

Trichomoniasis / BV (bacterial vaginosis) prevention:

< 45 kg: PO 15 mg/kg per day in 3 divided doses (max 2 g)  [?]

≥ 45 kg: PO 2 g STAT

Sexually Transmitted Diseases Treatment Guidelines, 2015 (CDC)

IM Ceftriaxone 250 mg STAT

PO 1 g STAT

PO 2 g STAT

Likas Protocol

(no age range / body weight specified)

IM 125 mg STAT

PO 20 mg/kg STAT

PO 15 mg/kg STAT

National Antimicrobial Guideline 2019 (Malaysia) – For Adult

Uncomplicated Gonorrhea (Urogenital, Anorectal, Pharyngeal) (including if pregnant):

IM 500 mg STAT + PO Azithromycin 1 g STAT

 

Uncomplicated Chlamydia (urogenital, pharyngeal and rectal infection):

PO 1 g STAT, then 500 mg OD x 2/7

OR

PO Doxycycline 100 mg BD x 7/7

Trichomoniasis treatment:

·       400 mg BD x 5-7 days OR

·       400 mg TDS for 7 days (in O&G) OR

·       2 g STAT

 

 

Sexually Transmitted Diseases Treatment Guidelines, 2015 (CDC)                                                                  https://www.cdc.gov/std/tg2015/tg-2015-print.pdf

§ If alcohol has been recently ingested or emergency contraception is provided, metronidazole or tinidazole can be taken by the sexual assault survivor at home rather than as directly observed therapy to minimize potential side effects and drug interactions. 

§ Postexposure hepatitis B vaccination (without HBIG) if the hepatitis status of the assailant is unknown and the survivor has not been previously vaccinated. If the assailant is known to be HBsAg-positive, unvaccinated survivors should receive both hepatitis B vaccine and HBIG. The vaccine and HBIG, if indicated, should be administered to sexual assault survivors at the time of the initial examination, and follow-up doses of vaccine should be administered 1–2 and 4–6 months after the first dose. Survivors who were previously vaccinated but did not receive postvaccination testing should receive a single vaccine booster dose.

§ HPV vaccination is recommended for female survivors aged 9–26 years and male survivors aged 9–21 years. For MSM with who have not received HPV vaccine or who have been incompletely vaccinated, vaccine can be administered through age 26 years. The vaccine should be administered to sexual assault survivors at the time of the initial examination, and follow-up dose administered at 1–2 months and 6 months after the first dose

 

Updated by JCK Ho @ 30.12.2020

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