From the Guidelines
The recommended first-line treatment for chlamydia urethritis is doxycycline 100 mg orally twice daily for 7 days, as it has higher cure rates and lower concerns about antimicrobial resistance compared to azithromycin 1.
Treatment Options
- Azithromycin 1 gram orally as a single dose is an alternative regimen, particularly for patients who cannot take doxycycline, such as pregnant women 1.
- Other alternative regimens include erythromycin base 500 mg orally four times a day for 7 days, erythromycin ethylsuccinate 800 mg orally four times a day for 7 days, ofloxacin 300 mg twice a day for 7 days, and levofloxacin 500 mg once daily for 7 days 1.
Important Considerations
- Patients should abstain from sexual activity for 7 days after treatment begins and until all partners have been treated to prevent reinfection 1.
- Partners from the previous 60 days should be notified, tested, and treated regardless of their test results 1.
- A test of cure is not routinely recommended for uncomplicated urethritis if the recommended regimen is completed, except in pregnant women who should be retested 3-4 weeks after treatment 1.
Mechanism of Action
- Doxycycline works by inhibiting bacterial protein synthesis, while azithromycin interferes with bacterial ribosomal function, both effectively eliminating the intracellular Chlamydia trachomatis infection 1.
From the FDA Drug Label
Uncomplicated urethral, endocervical, or rectal infection in adults caused by Chlamydia trachomatis: 100 mg, by mouth, twice a day for 7 days. The recommended dosing for chlamydia (Chlamydia trachomatis) urethritis treatment is 100 mg, by mouth, twice a day for 7 days 2.
- The dose may be administered with food, including milk or carbonated beverage, as required.
- Administration of adequate amounts of fluid along with capsule and tablet forms of drugs in the tetracycline class is recommended to wash down the drugs and reduce the risk of esophageal irritation and ulceration.
From the Research
Chlamydia Urethritis Treatment
The recommended dosing for chlamydia (Chlamydia trachomatis) urethritis treatment is as follows:
- A single 1-g dose of azithromycin is as effective as a standard seven-day course of doxycycline for the treatment of uncomplicated genital chlamydial infections 3, 4, 5, 6.
- Azithromycin has substantial activity against C. trachomatis, is concentrated intracellularly, and has a long half-life in serum and tissue 3.
- The rates of bacteriologic cure were similar for male and female patients treated with azithromycin 3.
- Single-dose therapy for chlamydial infection, which could be administered under supervision in the clinic, would be a significant advance in the management and public health control of chlamydial infections 4.
Comparison with Other Treatments
- Ofloxacin 400 mg bid for seven days is also effective against Chlamydia trachomatis 7.
- Doxycycline (100 mg orally twice daily for seven days) is a standard treatment for chlamydial urethritis, but it requires a longer treatment period compared to azithromycin 3, 5, 6.
- Ciprofloxacin (500 mg) is being increasingly used as a first-line medication, but caution is recommended due to the development of resistance 7.
Special Considerations
- For empirical treatment of the acute nongonococcal urethritis syndrome in men, a single oral dose of azithromycin was as effective as a standard 7-day course of doxycycline in achieving clinical cure 5.
- Treatment with a single oral dose of azithromycin appears to be as safe and efficacious as a 7-day course of doxycycline for the treatment of uncomplicated genital chlamydial infection in adolescents 6.