STI Drugs

jmanderson's version from 2015-12-03 22:04



Question Answer
Gonorrhea Uncomplicated (cervicitis, urethritis, rectal)ceftriaxone IM + azithromycin PO (alt. doxycycline if allergic)
Gonorrhea Disseminated in adultsCeftriaxone IM/IV q24h
Gonorrhea Prophylaxis in infants of infected mothersErythromycin or Tetracycline ophthalmic ointment
Chlamydia Adolescents and AdultsAzithromycin PO or Doxycycline PO
Chlamydia Pregnant WomenAzithromycin PO or Amoxicillin PO
Chlamydia Conjunctivitis of newborn or pneumonia in infantsErythromycin
Chlamydia Lymphogranuloma venereum (C. trachomatis)Drainage + Doxycline PO
Chlamydia Lymphogranuloma venereum (C. trachomatis) Pregnant PtsErythromycin Base
Syphilis Primary and secondary; Early latent (<1 y)Benzathine PCN G IM single dose
Syphilis Late latent or latent of unknown duration/tertiaryBenzathine PCN G IM x 3
Syphilis NeurosyphilisAqueous Crystalline PCN G or (if compliant) Procaine PCN + Probenecid
Syphilis Congenital SyphilisPCN
Genital Herpes 1st episodeAcyclovir, Famciclovir, or Valacyclovir PO
Genital Herpes Severe InfectionAcyclovir IV
Genital Herpes Recurrent episodesAcyclovir, Famciclovir, or Valacyclovir PO
Genital Herpes Daily Suppressive TherapyAcyclovir, Famciclovir, or Valacyclovir PO
Trichomoniasis DOCMetronidazole 2 g PO x 1 (same for pregnant pts too)
Bacterial vaginosis DOCMetronidazole 500 mg PO (same for pregnant pts too) or Clindamycin (alt)
HPV PreventionVaccines Cervarix (HPV 6, 11) or Gardasil (HPV 16, 18, 6, 11)
HPV Anal/vaginal Wartscryotherapy (liquid nitrogen) or bi/trichloracetic acid (BCA, TCA), surgery
HPV External gental/perianal warts (Patient Applied)Podofilox, Imiquimod, or Sinecatechins
HPV External gental/perianal warts (Provider Applied)Cryotherapy, Podophyllin, TCA, BCA, or surgery
Vaginal Candidiasis DOCAzole antifungals or Nystatin (less effective)
Pediculosis Pubis (pubic lice) DOCPediculosides (Permethrin, Pyethrin w/ piperonyl butoxide)



Question Answer
Cephalosporins (e.g., ceftriaxone) MOABinds penicillin-binding proteins used in bacterial cell wall synthesis; Inhibits transpeptidase rxn to form cross-links
PCNs (e.g., Amoxicillin, Benzathine PCN G) MOABinds penicillin-binding proteins used in bacterial cell wall synthesis; Inhibits transpeptidase rxn to form cross-links
Macrolides (e.g., Azithromycin, Erythromycin) MOAInhibit protein synthesis by binding to the 50S ribosomal subunit; Bacteriostatic
Tetracyclines (e.g., Doxycycline) MOAInhibit protein synthesis by binding to the 30S ribosomal subunit; Broad spectrum bacteriostatic
Tetracyclines (e.g., Doxycycline) PKOral (bioavail. 70-90%) or IV
Metronidazole MOAReactive reduction products (free nitro radicals) exert antimicrobial activity
Metronidazole PKWell absorbed; Widely distributed; Metabolized; Renally excreted
Fluoroquinolones (e.g., Ciprofloxacin) MOAInhibits bacterial DNA topoisomerases; Concentration dependent killing - bactericidal against Gm+ and Gm-
Clindamycin MOAInhibit protein synthesis by binding the 50S ribosomal subunit
Nucleoside Analogues (Acyclovir, etc.) MOAcompetitively inhibit viral DNA polymerase, causes chain termination of viral DNA
Nucleoside Analogues (Acyclovir, etc.) PKRoute: topical, oral, or IV; Dosing schedule is "not friendly" --> requires 5x a day+
Azole Antifungals examplesketoconazole, itraconazole, butoconazole, clotrimazole, fluconazole
Azole Antifungals MOAinhibit 14-alpha-demoethylase, blocks ergosterol synthesis
Azole Antifungals PKwell absorbed, keto/itraconazole require gastric acid, distributed to tissues and body fluids, hepatic metabolism, renal excretion
Pediculosides examplesPermethrin, Pyethrin w/ piperonyl butoxide
Pediculosides MOAact on insect nervous system (interfere Na-channels, muscle spasm, paralysis, death)



Question Answer
Cephalosporins (e.g., ceftriaxone) AEgenerally well tolerated, 5% “cross-sensitivity” w/ PCNs
PCNs (e.g., Amoxicillin, Benzathine PCN G) AEHypersensitivity rxns, rash, Jarisch-Herxheimer reaction (fever, HA, myalgia w/in 24 h)
PCNs (e.g., Amoxicillin, Benzathine PCN G) DIPairing antibiotic with a β-lactamase inhibitor could increase activity (decrease bacteria)
Macrolides (e.g., Azithromycin, Erythromycin) AEGI (diarrhea), cholestatic hepatitis (rare), CYP 450 3A4 inhibitors (not azithromycin), QT prolongation (azithromycin, telithromycin)
Tetracyclines (e.g., Doxycycline) AEteeth discoloration (avoid in pregnancy and kids < 8 yo), photosensitization, esophageal ulcers
Tetracyclines (e.g., Doxycycline) DIdi- and trivalent cations (Ca++ Al++ Fe++) and antacids reduce F
Metronidazole AEgenerally well tolerated, nausea, epigastric pain, metallic taste, disulfiram-like reaction with etOH (N/V, sweating, flushing, dyspnea, palpitations)
Metronidazole DIetOH
Fluoroquinolones (e.g., Ciprofloxacin) AEtendonitis and rupture, CI in pregnancy and kids (cartilage damage), glucose exursions, phototoxcity, QT prolongation
Fluoroquinolones (e.g., Ciprofloxacin) DICaffeine (P4501A2 inhibition) and di/trivalent cations (dairy products, antacids)
Clindamycin AEmay weaken latex condoms/diaphragms, diarrhea, C. diff colitis (diarrhea, abdominal pain, fever)
Nucleoside Analogues (Acyclovir, etc.) AEwell tolerated, HA, nausea, diarrhea, pregnancy Cat B
Ablative Modalities AEhypo/hyperpigmentation common AE
Podofilox (antimitotic) AEmild - moderate pain or local irritation
Imiquimod (stimulates production of interferon & other cytokines) AElocal inflammatory reactions, redness, irritation, induration, ulceration/erosions, and vesicles
Sinecatechins (green tea extract) AEerythema, pruritus/burning, pain, ulceration, edema, induration, and vesicular rash; may weaken condoms and diaphragms
Cryotherapy AEpain after application of the liquid nitrogen, followed by necrosis and sometimes blistering
Azole Antifungals AEN/V/D and hepatotoxicity (oral); vaginal burning, stinging, irritation (topical); decrease efficacy of latex condoms/diaphragms (topical)
Azole Antifungals DI2C9/9, 3A4 inhibitors, HMG-CoA reductase inhibitors (statins), warfarin
Pediculosides AEirritation, itching, paresthesia

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