Gonorrhoea (Uncomplicated Genital Infection)

1 g intramuscularly as a single dose. Reconstitute in 1% lidocaine - a 1 g IM injection is painful and that is a real reason people refuse it. If chlamydia has not been excluded, add doxycycline 100 mg twice daily for 7 days - Single dose

25-50 mg/kg/dose [child max 250 mg]

(Children under 45 kg: 25-50 mg/kg IM single dose, maximum 250 mg - not the adult 500 mg. Neonatal gonococcal ophthalmia requires emergency parenteral treatment under paediatric specialist care.)

This mg/kg figure applies up to 45 kg only - above that, dose on specialist advice

WATCH group - carries resistance cost. Egyptian EML 2025.

BASHH UK National Guideline for the Management of Infection with Neisseria gonorrhoeae, 2025, sections 11.2 and 11.3

BASHH raised this from 500 mg to 1 g. Ceftriaxone still works - most infections with reduced susceptibility are still cleared at 1 g, and the few reported failures have been pharyngeal. Egypt sells 39 different 1 g vials and the cheapest is 22 EGP, so the higher dose costs almost nothing here.

400 mg orally, then a second 400 mg 6-12 hours later, PLUS azithromycin 2 g orally as a single dose (or 1 g then another 1 g 6-12 hours later, which is easier on the stomach). Add doxycycline 100 mg twice daily for 7 days if chlamydia is not excluded - two cefixime doses 6-12 hours apart, on one day

8 mg/kg/dose [child max 400 mg]

(Children <45 kg: 8 mg/kg single oral dose (max 400 mg). Specialist pediatric consultation required.)

WATCH group - carries resistance cost. Egyptian EML 2025.

BASHH UK National Guideline for the Management of Infection with Neisseria gonorrhoeae, 2025, sections 11.2 and 11.3

Only when an intramuscular injection is genuinely contraindicated AND susceptibility results are in hand. The single 800 mg dose is gone: BASHH split it into two 400 mg doses because what clears the organism is the time the free drug stays above the MIC, not the peak - and a second dose achieves that where a bigger single one does not.

2 g by mouth as a single dose, taken with the gentamicin injection - single dose

No paediatric dose for this regimen in the sources opened.

WATCH group - carries resistance cost. Egyptian EML 2025.

Gonorrhea - StatPearls - NCBI Bookshelf (NBK558903)

The second half of the fallback regimen for the patient who cannot have a cephalosporin; neither drug clears gonorrhoea reliably on its own at these doses.

240 mg as a single intramuscular dose, given together with azithromycin 2 g orally as a single dose - single dose

No paediatric dose for this regimen in the sources opened.

Gonorrhea - StatPearls - NCBI Bookshelf (NBK558903)

Ceftriaxone and cefixime are both cephalosporins, so the patient with a severe cephalosporin allergy needs another route. This is the one the article gives for that patient, and it is one injection given in the clinic rather than a hospital regimen.

100 mg twice a day x 7 days

No paediatric dose for this co-treatment in the sources opened.

Gonorrhea - StatPearls - NCBI Bookshelf (NBK558903)

Gonorrhoea and chlamydia are caught together often enough that the article treats both unless chlamydia has been ruled out by a test. Covering only the gonococcus leaves the second half of the standard visit undone.