PH8.4 | PH8.4 | Syndromic Antibacterial Treatment Plans — SDL Guide — Summary & Reflection

KEY TAKEAWAYS

UTI treatment: Uncomplicated cystitis — nitrofurantoin 100mg MR × 5d (preferred; not for pyelonephritis or eGFR <30), fosfomycin 3g single dose, TMP-SMX only if local resistance <20%. Pyelonephritis — fluoroquinolone 7d (oral) or cephalosporin 14d; IV ceftriaxone if systemically unwell. Complicated UTI — culture-directed, 7–14 days, address underlying cause. CAUTI — treat only if symptomatic. Asymptomatic bacteriuria — treat only in pregnancy and pre-urological procedure.

STD treatment (Indian guidelines 2024): Gonorrhoea — ceftriaxone 500mg IM single dose (NOT fluoroquinolones, >50% resistance); + azithromycin 1g if chlamydia co-infection likely. Chlamydia — azithromycin 1g single dose (preferred compliance) OR doxycycline 100mg BD × 7d (preferred for rectal chlamydia); avoid doxycycline in pregnancy (use azithromycin). Syphilis — benzathine penicillin G 2.4 MU IM (primary/secondary × 1, latent × 3 weekly); neurosyphilis — IV aqueous penicillin G × 14d; pregnant with penicillin allergy — desensitise. PID — ceftriaxone + doxycycline + metronidazole × 14 days.

Patient counselling essentials: complete the course; partner treatment mandatory for all STDs; Jarisch-Herxheimer warning for syphilis (not an allergy); doxycycline — no dairy/antacids, stay upright; metronidazole — avoid alcohol × 48 hours after last dose.

REFLECT

A 22-year-old woman diagnosed with chlamydia at a government STD clinic is too embarrassed to tell her partner. She asks you to just prescribe enough medicine for both of them and she will put it in his food without him knowing. How do you respond? What are the ethical and pharmacological issues with her request? And what is the evidence-based alternative that respects patient autonomy while still serving the public health goal of STD control?