What is the recommended treatment for chlamydia?

Treatment for Chlamydia

Doxycycline 100 mg orally twice daily for 7 days is the recommended first-line treatment for chlamydia due to its superior efficacy (95.5% cure rate) compared to azithromycin. 1

First-Line Treatment Options

Adults and Adolescents (≥8 years)

• Preferred regimen:

  • Doxycycline 100 mg orally twice daily for 7 days 1, 2
  • Alternative formulation: Doxycycline hyclate delayed-release 200 mg tablet orally once daily for 7 days (may improve adherence with fewer GI side effects) 1

• Alternative regimen:

  • Azithromycin 1 g orally in a single dose 1, 3
    • Efficacy approximately 92% for genital infections 1
    • May be preferred when medication adherence is a concern 1, 4

Special Populations

Children (<8 years)

• Preferred regimen:
  • Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into four doses daily for 14 days 5, 6

Children (≥8 years, <45 kg)

• Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into four doses daily for 14 days 5

Children (≥8 years, >45 kg but <100 lbs)

• Azithromycin 1 g orally in a single dose 5

Anatomical Site Considerations

Rectal Chlamydia

• Doxycycline strongly preferred over azithromycin
  • Doxycycline efficacy: 96.9% 7
  • Azithromycin efficacy: 76.4% 7
  • Adjusted risk difference: 19.9 percentage points in favor of doxycycline 7

Important Clinical Considerations

Contraindications and Cautions

• Doxycycline:

  • Contraindicated in pregnancy 1
  • Should be taken with adequate fluid to reduce risk of esophageal irritation 2
  • Can be taken with food if gastric irritation occurs 2

• Azithromycin:

  • Contraindicated in patients with current non-tuberculous mycobacterial (NTM) infection 1
  • Safe in pregnancy (when doxycycline cannot be used)

Patient Instructions

1. Complete the entire course of medication even if symptoms resolve quickly
2. Abstain from sexual activity for 7 days after treatment initiation
3. Ensure all partners from past 60 days are notified, evaluated, and treated
4. Return for reevaluation if symptoms persist or recur after treatment 1

Follow-up

• No test of cure needed if symptoms resolve after completing treatment
• Test of cure recommended ≥3 weeks after treatment if symptoms persist
• Repeat testing recommended in 3-6 months due to high risk of reinfection 1

Treatment Efficacy Comparison

Medication	Urogenital Infection	Rectal Infection	Advantages	Disadvantages
Doxycycline	95.5%	96.9%	Higher efficacy, especially for rectal infections	7-day course may reduce adherence
Azithromycin	92%	76.4%	Single-dose improves adherence	Lower efficacy, especially for rectal infections

Complications of Untreated Infection

• Women: Pelvic inflammatory disease, ectopic pregnancy, infertility 1
• Men: Epididymitis, Reiter's syndrome 1
• Both: Increased risk of HIV transmission

Doxycycline's superior efficacy, particularly for rectal infections, makes it the preferred first-line treatment despite the longer treatment duration. The single-dose azithromycin regimen remains a valuable alternative when adherence to a 7-day regimen is a concern, but patients should be informed of its lower efficacy, especially for rectal infections 1, 7.