Outpatient therapy

1. For outpatient therapy, the CDC recommends either oral ofloxacin (Floxin, 400 mg twice daily) or levofloxacin (Levaquin, 500 mg once daily)

with or without metronidazole (Flagyl, 500 mg twice daily) for 14 days. An alternative is an initial single dose of ceftriaxone (Rocephin, 250 mg IM), cefoxitin (Mefoxin, 2 g IM plus probenecid 1 g orally), or another parenteral third-generation cephalosporin, followed by doxycycline (100 mg orally twice daily) with or without metronidazole for 14 days. Quinolones are not recommended to treat gonorrhea acquired in California or Hawaii. If the patient may have acquired the disease in Asia, Hawaii, or California, cefixime or ceftriaxone should be used.

2. Another alternative is azithromycin (Zithromax, 1 g PO for Chlamydia coverage) and amoxicillin-clavulanate (Amoxicillin, 875 mg PO) once by directly observed therapy, followed by amoxicillin-clavulanate (Amoxicillin, 875 mg PO BID) for 7 to 10 days.

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