What is the treatment (tx) for chlamydia?

Treatment for Chlamydia

Doxycycline 100mg orally twice daily for 7 days is the first-line treatment for chlamydia, with cure rates of 97-98%. 1

First-Line Treatment Options

• For non-pregnant adults and adolescents:

  • Doxycycline 100mg orally twice daily for 7 days 1

• For pregnant patients:

  • Azithromycin 1g orally in a single dose 1

• Alternative regimens for patients who cannot tolerate doxycycline:

  • Erythromycin 500mg orally four times daily for at least 7 days 2
  • For those who cannot tolerate the full erythromycin dose: 500mg orally every 12 hours or 250mg orally four times daily for at least 14 days 2

Special Populations

• Children:

  • <45kg: Erythromycin base or ethylsuccinate 50mg/kg/day orally divided into four doses daily for 14 days 1

  • 45kg but <8 years: Azithromycin 1g orally in a single dose 1

  • 8 years: Azithromycin 1g orally in a single dose or doxycycline 100mg orally twice daily for 7 days 1

• HIV-positive patients:

  • Same treatment regimens as those without HIV, but more vigilant follow-up may be needed 1

Partner Management

• All sexual partners from the past 60 days should be notified, examined, and treated regardless of their test results 1
• Both patients and partners should abstain from sexual intercourse until therapy is completed and both are asymptomatic 1

Follow-Up Recommendations

• Rescreening is recommended 3-6 months after treatment due to high risk of reinfection 1
• Patients should complete all medication even if symptoms resolve quickly 1

Medication Administration Considerations

• To maximize compliance, medications should be dispensed on site and the first dose directly observed 1
• For patients with poor compliance history or unpredictable follow-up, azithromycin may be more appropriate despite its higher cost 1
• Single-dose azithromycin has been shown to be as effective as a 7-day course of doxycycline in multiple studies, with microbial cure rates of 97% for azithromycin and 98% for doxycycline 3

Common Pitfalls and Caveats

• Treatment failure causes:

  • Inadequate partner treatment is the most common cause of reinfection 1
  • Incomplete therapy or treating only one infection when multiple are present 1
  • Poor medication compliance with multi-day regimens

• Important clinical considerations:

  • Always test for other STIs, especially gonorrhea, which commonly co-occurs with chlamydial infections 1
  • Consider testing for syphilis and HIV 1
  • Risk factors for persistence or recurrence include: age ≤24, recent new partner, multiple partners, or partners who may have had multiple partners 4