What is the treatment for chlamydia?

Treatment for Chlamydia

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

Treatment Recommendations by Patient Population

Adults and Adolescents

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

Pregnant Women

• Recommended treatment:
  • Azithromycin 1g orally in a single dose (doxycycline is contraindicated in pregnancy) 1
  • Alternative: Erythromycin 500mg orally four times daily for at least 7 days 2
  • For women who cannot tolerate this regimen: Erythromycin 500mg orally every 12 hours or 250mg orally four times daily for at least 14 days 2

Children

• For children weighing <45kg:
  • Erythromycin base or ethylsuccinate 50mg/kg/day orally divided into four doses daily for 14 days 3, 1
• For children weighing >45kg but aged <8 years:
  • Azithromycin 1g orally in a single dose 1
• For children aged >8 years:
  • Azithromycin 1g orally in a single dose OR
  • Doxycycline 100mg orally twice daily for 7 days 3, 1

Clinical Considerations

Treatment Efficacy

• Single-dose azithromycin and 7-day doxycycline regimens have comparable efficacy for uncomplicated urogenital chlamydial infections 4, 5
• For rectal chlamydia infections, doxycycline may be more effective than azithromycin (99.6% vs 82.9% efficacy) 6

Medication Administration

• Erythromycin tablets are well absorbed and may be dosed orally without regard to meals, though optimal blood levels are obtained when taken in the fasting state (at least 30 minutes and preferably 2 hours before meals) 2
• Single-dose therapy with azithromycin offers the advantage of directly observed therapy and improved compliance compared to multi-dose regimens 7, 8

Post-Treatment Recommendations

• Patients should abstain from sexual intercourse until:
  • 7 days after single-dose therapy OR
  • Until completion of the 7-day regimen AND
  • Until all partners are treated 1

Partner Management

• All sexual partners from the past 60 days should be notified, examined, and treated regardless of their test results 1
• Untreated partners are a significant risk factor for reinfection 4

Follow-Up Testing

Test of Cure

• Recommended for:
  • Pregnant women (3-4 weeks after treatment completion)
  • When alternative regimens like erythromycin are used
  • When there are concerns about adherence, persistent symptoms, or suspected reinfection 1
• Should be conducted ≥3 weeks after treatment completion using Nucleic Acid Amplification Tests (NAATs) or culture-based methods 1

Rescreening

• Recommended 3-6 months after treatment due to high risk of reinfection 1

Important Considerations and Pitfalls

• Co-infection risk: Always test for other STIs, especially gonorrhea, which commonly co-occurs with chlamydial infections 1
• Treatment failure vs. reinfection: Treatment failure is uncommon with recommended regimens; most post-treatment positive tests result from reinfection from untreated partners 4
• Compliance challenges: While doxycycline is highly effective, the 7-day regimen may lead to poor compliance; single-dose azithromycin may be preferable for patients with poor compliance history 1, 7
• Rectal infections: Consider doxycycline for known rectal infections due to potentially higher efficacy 6
• Patient education: Emphasize the importance of:
  • Completing the full course of medication even if symptoms resolve
  • Partner treatment to prevent reinfection
  • Abstaining from sexual activity during the treatment period
  • Consistent condom use to prevent future infections 1