What is the treatment for Chlamydia (Chlamydia trachomatis) infection?

From the Guidelines

Chlamydia treatment should be initiated with a single 1-gram dose of azithromycin or doxycycline 100mg twice daily for 7 days, as recommended by the Centers for Disease Control and Prevention (CDC) 1.

Treatment Options

• Azithromycin is preferred for pregnant women as doxycycline can affect fetal development 1.
• The standard regimen for non-pregnant women is either a single 1-gram dose of azithromycin or doxycycline 100mg taken twice daily for 7 days 1.
• It is crucial to complete the full course of antibiotics even if symptoms disappear.
• Sexual partners should also be treated simultaneously to prevent reinfection.

Treatment Outcomes

• Treatment is highly effective, with cure rates exceeding 95% when taken as prescribed 1.
• If symptoms persist after treatment, a healthcare provider should be consulted as this may indicate reinfection or antibiotic resistance.

Follow-up Care

• Follow-up testing is recommended 3-4 months after treatment to ensure the infection has cleared.
• Patients should abstain from sexual activity for 7 days after single-dose treatment or until completing the 7-day course.

Additional Considerations

• The CDC updates treatment recommendations regularly, and clinicians should access the CDC Web site to obtain the most up-to-date information 1.
• Nucleic acid amplification tests have high specificity and sensitivity when used as screening tests for chlamydial infection, and can be used with urine and vaginal swabs 1.

From the FDA Drug Label

For adults with uncomplicated urethral, endocervical, or rectal infections caused by Chlamydia trachomatis, when tetracycline is contraindicated or not tolerated 500 mg of erythromycin by mouth four times a day for at least 7 days. Urogenital Infections During Pregnancy Due to Chlamydia trachomatis Although the optimal dose and duration of therapy have not been established, the suggested treatment is 500 mg of erythromycin by mouth four times a day on an empty stomach for at least 7 days For women who cannot tolerate this regimen, a decreased dose of one erythromycin 500 mg tablet orally every 12 hours or 250 mg by mouth four times a day should be used for at least 14 days.

The recommended treatment for Chlamydia with erythromycin is:

• 500 mg by mouth four times a day for at least 7 days in adults with uncomplicated infections
• 500 mg by mouth four times a day for at least 7 days in pregnant women, or
• 250 mg by mouth four times a day for at least 14 days if the patient cannot tolerate the higher dose 2

From the Research

Chlamydia Treatment Options

• Azithromycin and doxycycline are two commonly used antibiotics for the treatment of chlamydia 3, 4, 5, 6, 7
• A single 1-g dose of azithromycin has been shown to be as effective as a standard seven-day course of doxycycline for the treatment of uncomplicated genital chlamydial infections 3, 6
• However, for the treatment of rectal chlamydia, doxycycline may be more effective than azithromycin 5, 7
• A systematic review and meta-analysis found that doxycycline had a higher microbiological cure rate than azithromycin for the treatment of rectal chlamydia 7

Efficacy of Azithromycin and Doxycycline

• Azithromycin:
  • Effective for the treatment of uncomplicated genital chlamydial infections 3, 6
  • May not be as effective as doxycycline for the treatment of rectal chlamydia 5, 7
• Doxycycline:
  • Effective for the treatment of uncomplicated genital chlamydial infections 3, 6
  • May be more effective than azithromycin for the treatment of rectal chlamydia 5, 7

Treatment Recommendations

• For uncomplicated genital chlamydial infections, either azithromycin or doxycycline may be used 3, 6
• For rectal chlamydia, doxycycline may be preferred over azithromycin due to its higher efficacy 5, 7