RR, a 26 year-old male with no PMH, presents to the emergency room because he is experiencing urethral discharge and itching. Patient reports he had unprotected sex 2 weeks ago and has never been tested for any sexually transmitted infections (STIs).
The nurse performs a nucleic acid amplification test and the results are:
Chlamydia testing: Positive
Gonorrhea testing: Negative
Vitals:
Ht: 6’2’’
Wt: 230 lb
BP: 110/67 mmHg
HR: 74 BPM
How would you like to treat RR’s STI?
A. Rocephin 500 mg IM once
B. Zovirax 400 mg PO TID for 7 days
C. Vibramycin 100 mg PO BID for 7 days
D. Benzathine penicillin G 2.4 million units IM once
Answer with Rationale:
The CDC reported over 1.6 million cases of chlamydia in 2023. Sexually transmitted infections can have long term side effects if not treated properly. Some long term side effects include infertility, ectopic pregnancy, and HPV cancer. Pharmacists should be able to read diagnostic tools and know the first line treatment options for sexually transmitted infections.
Answer A is incorrect. Rocephin is first-line treatment for N. gonorrhoeae. When treating C. trachomatis, sometimes doctors opt to treat both chlamydia and gonorrhea at the same time as co-infection rates are high, around 40-50%. A one-time dose of 500mg IM is recommended in adults weighing < 150kg while 1gm IM is recommended in patients > or = 150kg.
Answer B is incorrect. Zovirax is the first-line treatment for herpes simplex virus.
Answer C is correct. Vibramycin is the first line option for treating chlamydia. Azithromycin was a first-line therapy for many years, but resistance rates to C. trachomatis have increased necessitating doxycycline replacement as the first-line therapy. Azithromycin would still be preferred in a pregnant female.
Answer D is incorrect. Benzathine penicillin G is the first line treatment for syphilis.
Brand/generics Covered:
Ceftriaxone (Rocephin), Acyclovir (Zovirax), Doxycycline (Vibramycin), Benzathine penicillin G (Bicillin L-A)
Naplex Competencies Covered:
1.1 Diagnostic findings
1.2 Lifestyle habits
1.5 Signs or symptoms of medical conditions, etiology of diseases
1.6 Risk factors or maintenance of health and wellness
2.2 Brand, generic
3.4 Drug dosing; duration of therapy
3.5 Drug route of administration
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