What is the recommended treatment for chlamydia?

Treatment for Chlamydia

The recommended first-line treatment for uncomplicated chlamydia infection is either azithromycin 1g orally in a single dose or doxycycline 100mg orally twice daily for 7 days, with cure rates of 97-98%. 1

First-Line Treatment Options

• Azithromycin: 1g orally in a single dose
• Doxycycline: 100mg orally twice daily for 7 days

Both treatments are highly effective, but there are important considerations when selecting between them:

Advantages of Azithromycin

• Single-dose therapy allows for direct observation of treatment
• Better for patients with poor compliance history
• Can be administered on-site to ensure completion
• Preferred for pregnant patients 1

Advantages of Doxycycline

• May have higher efficacy for rectal chlamydia infections 2
• Lower cost than azithromycin
• FDA-approved dosing for chlamydia is well-established 3

Alternative Treatment Options

For patients who cannot tolerate first-line treatments:

• Ofloxacin 300mg orally twice daily for 7 days
• Levofloxacin 500mg orally once daily for 7 days
• Erythromycin base 500mg orally four times daily for 7 days
• Erythromycin ethylsuccinate 800mg orally four times daily for 7 days 1

Special Populations

Pregnant Patients

• First choice: Azithromycin 1g orally in a single dose
• Alternatives: Amoxicillin or erythromycin base 1

Children

• <45kg: Erythromycin base or ethylsuccinate 50mg/kg/day orally divided into four doses daily for 14 days
• >45kg but <8 years: Azithromycin 1g orally in a single dose
• >8 years: Azithromycin 1g orally in a single dose or doxycycline 100mg orally twice daily for 7 days 1

For children with chlamydial pneumonia or conjunctivitis, erythromycin 50 mg/kg/day in 4 divided doses is recommended for at least 2-3 weeks 4

Post-Treatment Recommendations

• Patients should abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen
• All sexual partners within the preceding 60 days should be treated
• Partners should be encouraged to seek comprehensive STI testing, including for gonorrhea, syphilis, and HIV 1

Follow-up Care

• Rescreening is recommended 3-6 months after treatment due to high risk of reinfection
• Routine test-of-cure is not recommended after treatment with azithromycin or doxycycline unless symptoms persist or reinfection is suspected 1

Important Clinical Considerations

• Always test for other STIs, especially gonorrhea, which commonly co-occurs with chlamydia
• Consider testing for syphilis and HIV
• To maximize compliance, medications should be dispensed on-site and the first dose directly observed when possible
• For patients with poor compliance history, azithromycin may be more appropriate despite higher cost 1

Common Pitfalls to Avoid

1. Failing to treat partners: Ensure all sexual partners from the past 60 days are treated to prevent reinfection
2. Inadequate follow-up: Remember to recommend rescreening at 3-6 months
3. Missing co-infections: Always test for other STIs, especially gonorrhea
4. Poor medication adherence: For multi-day regimens, emphasize the importance of completing the full course even if symptoms resolve

The high efficacy of both azithromycin and doxycycline makes them excellent choices for treating chlamydia, with the decision between them often depending on concerns about adherence, pregnancy status, and site of infection.