STD Pharm
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| Gonorrhea Therapeutic principles ? | * Be highly effective at all anatomic sites of infection
--- Be well tolerated (particularly in patients with recurrent infections)
--- Offer the feasibility of single-dose therapy at the point of care
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| Therapeutic regimens should ? | * have efficacy rates of greater than 95 percent because treatment failure
has significant public health implications related to ongoing transmission of infection
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| Why single dose therapy ? | * B/c it ups the adherence rate of patients to stop their disease and stop its spread....... also see lower drug resistance and lower side effects.... * Drug = ceftriaxone (single dose and high efficacy)
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| The selection of antibiotics for the treatment of gonorrhea must also include the possibility of ? | * Copathogens, such as Chlamydia
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| Antibiotic resistance and Gono. ? | * recently strains are becoming more and more resistant to drugs and even multiple drugs
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| Happened due to antibiotic resistance ? | * ceftriaxone as a single agent for gono is no longer recommended....... * ceftriaxone should be administered in combo w/ either azithromycin or doxycycline, regardless of chlamydial coinfection status
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| Current Tmt for Gono. = ? | * For uncomplicated = Ceft. (IM) + Azithro. (Oral)...* Doxy can be used instead of Azithro.
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| Why no Azithro. mono-therapy ? | * even though it could easily take care of both Gono and Chlamydia, its has high GI SEs and we are trying to not get Gono resistance to Azithro.
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| Disseminated gonococcal infection (DGI) is seen in who ? | * under 40, DGI is a common cause of acute polyarthralgias, polyarthritis, or oligoarthritis in young
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| Patients with disseminated gonococcal infection (DGI) typically present with one of two syndromes ? | * 1) A triad of tenosynovitis, dermatitis, and polyarthralgias without purulent arthritis.... * 2) Purulent arthritis without associated skin lesions.
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| DGI TmT = ? | * Parenteral therapy w/ ceftriaxone is the preferred initial tmt .... * Pts should also receive a single oral dose of azithromycin, for dual coverage of Chlamydia co-infection.... * Can also use Doxy instead of Azithro.
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| Gonococcal urethritis tmt ? (men with Sx of urethritis with G- diplococci, must receive tmt as if co-infected) | * a single intramuscular dose of ceftriaxone and a single oral dose of azithromycin..... * Doxy can be used instead of Azithro. again
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| Chlamydia trachomatis TmT = ? | * most common bacterial STI.... * use Tetracyclines ( Doxy.) or Macrolides (Azithro.).... * Azithro - can be given once a day due to its t1/2..... * Doxy. - cheaper, but need a 7 day tmt with 2 a day dosing
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| Highly effective alternative agent, but can not be used in pregs., adolescence, and is more expensive ? | * Levofloxacin
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| Trichomonas vaginalis Tmt = ? | * most common non-viral STD ..... * TmT = The 5-nitroimidazole drugs --> Metronidazole orally
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| Metronidazole SEs ? | * Metallic Taste (unique!)..... * disulfiram-like RxN, so don't drink with it
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| Metronidazole use ? | * Metronidazole is the gold standard anti-anaerobic agent.... * It is a first line agent for giardiasis, trichomoniasis, and amebiasis..... *
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| Syphilis is a chronic infection caused by ? | * the bacterium Treponema pallidum
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| Syphilis TmT = ? | * long term tmt bc it divides slowly.... * For this reason, long-acting penicillin preparations are the preferred drugs for
the treatment of all stages of syphilis..... * Only the long-acting benzathine preparation should be used (given IM)
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| Options for the treatment of early syphilis in penicillin allergic patients include ? | * Doxy. = first to use if non-pregnant.... * Azithro. = given if you think they won't adhere to the Doxy double a day dosing
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| Bacterial vaginosis basics ? | * most common vaginal discharge issue of women in child bearing age..... * BV resolves spontaneously in up to one-third of nonpregnant and one-half of pregnant women.
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| BV TmT = ? | * Metronidazole or clindamycin administered either orally or intravaginally
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| Candida vulvovaginitis basics ? | * 2nd most common, after BV..... * inflammation of vagina and vulva....* Not considered an STD like Tricg. Vag.
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| Candida Vulvovaginitis TmT = ? | * relief of symptoms..... * tmt based on umcomplicated (tmt helps in days) vs. complicated (tmt is needed for longer course)... * Uncomp. = an antimycotic such as Monostat or fluconazoles..... *Comp. = flu or clot -azole
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