What is the recommended treatment for chlamydia?

Recommended Treatment for Chlamydia

For uncomplicated chlamydial infections in adults, the recommended first-line treatment is doxycycline 100mg orally twice daily for 7 days, which is preferred over azithromycin due to higher cure rates. 1

Treatment Regimens by Population

Adults

• First-line treatment:

  • Doxycycline 100mg orally twice daily for 7 days 1, 2

• Alternative treatment:

  • Azithromycin 1g orally in a single dose 1, 3

Pregnant Women

• Recommended treatment:
  • Azithromycin 1g orally in a single dose (doxycycline is contraindicated) 1

Children

• For children <45kg:

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

• For children >45kg but <8 years:

  • Azithromycin 1g orally in a single dose 1

• For children >8 years:

  • Azithromycin 1g orally in a single dose OR
  • Doxycycline 100mg orally twice daily for 7 days 1, 2

Important Clinical Considerations

Testing

• Always test for other STIs, especially gonorrhea, which commonly co-occurs with chlamydial infections 1, 4
• Nucleic Acid Amplification Tests (NAATs) are the preferred testing method 1
• Acceptable specimen types include vaginal, endocervical, rectal, pharyngeal, urethral swabs, and first-stream urine samples 4

Follow-up and Test of Cure

• Test of cure is recommended for:
  • Pregnant women
  • When alternative regimens are used
  • When there are concerns about adherence
  • When symptoms persist
  • When reinfection is suspected 1, 4
• Test of cure should be conducted ≥3 weeks after treatment completion 1
• Rescreening is recommended 3-6 months after treatment due to high risk of reinfection 1, 4

Partner Management

• All sexual partners from the past 60 days should be notified, examined, and treated regardless of test results 1, 5
• Partners should be offered treatment without waiting for test results 5

Patient Instructions

• Abstain from sexual intercourse until:
  • 7 days after single-dose therapy OR
  • Until completion of 7-day regimen AND
  • Until all partners are treated 1
• Complete all medication even if symptoms resolve quickly 1

Common Pitfalls and Caveats

1. Medication compliance: For patients with poor compliance history, directly observed single-dose therapy with azithromycin may be preferable, though doxycycline is more effective 1

2. Missed co-infections: Always test for other STIs, including gonorrhea, syphilis, and HIV 1, 4

3. Inadequate partner treatment: Failure to treat partners is a major cause of reinfection 1, 5

4. Pregnancy considerations: Doxycycline is contraindicated in pregnancy; azithromycin is the recommended alternative 1, 4

5. Recurrent infections: High rates of recurrence may be due to reinfection or persistent infection 6

6. Test of cure timing: Testing too early (before 3 weeks) may lead to false positive results due to non-viable organisms 1