What is the treatment for chlamydia?

Treatment of Chlamydia Infection

The first-line treatment for chlamydia is doxycycline 100mg orally twice daily for 7 days, with azithromycin 1g orally as a single dose being an acceptable alternative when adherence is a concern. 1

Treatment Regimens by Patient Population

Adults and Adolescents (≥8 years)

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

Children

• <45kg: Erythromycin base or ethylsuccinate 50mg/kg/day orally divided into four doses for 14 days 1, 2
• >45kg but <8 years: Azithromycin 1g orally as a single dose 1

Pregnant Women

• Recommended: Azithromycin 1g orally as a single dose 1
  • Doxycycline is contraindicated in pregnancy 1
• Alternative: Erythromycin 500mg orally four times daily for at least 7 days 2
  • If not tolerated, 500mg orally every 12 hours or 250mg orally four times daily for at least 14 days 2

Efficacy Considerations

While both treatments are effective, there are important differences to consider:

• Doxycycline has demonstrated superior efficacy for rectal chlamydial infections, with studies showing 99.6% cure rates compared to 82.9% for azithromycin 3
• Single-dose azithromycin offers the advantage of directly observed therapy and improved adherence 4
• Clinical trials have shown comparable efficacy between azithromycin and doxycycline for uncomplicated genital chlamydial infections, with cure rates of 96% and 98% respectively 5

Patient Management Guidelines

• Patients should abstain from sexual activity until:

  • 7 days after single-dose therapy, OR
  • Until completion of the 7-day doxycycline regimen, AND
  • Until all partners are treated 1

• Partner notification and treatment:

  • All sexual partners from the past 60 days should be notified, examined, and treated regardless of test results 1
  • Partner treatment is critical to prevent reinfection 1

• Follow-up testing:

  • Test of cure is recommended for:
    • Pregnant women
    • When alternative regimens are used
    • When there are concerns about adherence
    • Persistent symptoms
    • Suspected reinfection 1
  • 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

Important Clinical Considerations

• Always test for other STIs, including HIV and syphilis 1
• For patients with poor compliance history, directly observed single-dose therapy with azithromycin may be preferable 1
• If chlamydia and gonorrhea co-infection is present, treat with ceftriaxone 500mg IM single dose PLUS the appropriate chlamydia treatment 1
• Patient education should emphasize:
  • Completing the full course of medication even if symptoms resolve
  • Partner treatment importance
  • Safe sex practices including consistent condom use 1

Common Pitfalls to Avoid

• Failing to treat partners, which leads to high reinfection rates
• Not testing for other STIs when chlamydia is diagnosed
• Inadequate follow-up, especially for high-risk patients
• Using azithromycin for rectal chlamydia infections, where doxycycline has superior efficacy
• Not considering pregnancy status before prescribing doxycycline