What is the recommended treatment for chlamydia?

Treatment for Chlamydia

For uncomplicated chlamydial infections, doxycycline 100 mg orally twice daily for 7 days is the preferred first-line treatment due to its higher efficacy rate of approximately 98% compared to azithromycin's 97%. 1, 2

First-Line Treatment Options

• Doxycycline 100 mg orally twice daily for 7 days (approximately 98% efficacy) is the preferred first-line treatment for uncomplicated chlamydial infections 1, 2
• Azithromycin 1 g orally in a single dose (approximately 97% efficacy) is an alternative first-line option, particularly useful when compliance with multi-day regimens is questionable 1, 2
• Medications should be dispensed on-site when possible, with the first dose directly observed to maximize compliance 1

Alternative Treatment Options

• Erythromycin base 500 mg orally four times a day for 7 days 1, 3
• Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days 1
• Ofloxacin 300 mg orally twice a day for 7 days 1, 2
• Levofloxacin 500 mg orally once daily for 7 days 1, 2

Special Populations

Pregnancy

• Azithromycin 1 g orally in a single dose is the preferred treatment during pregnancy 2, 4
• Amoxicillin 500 mg orally three times a day for 7 days is an alternative option during pregnancy 1, 2
• Doxycycline is contraindicated during pregnancy 2, 4

Children

• For children ≥8 years who weigh >45 kg: same as adult dosing 2, 5
• For children ≥8 years who weigh <45 kg: 2 mg/lb of body weight divided into two doses on the first day, followed by 1 mg/lb of body weight given as a single daily dose or divided into two doses on subsequent days 2, 5

Implementation Considerations

• Patients should abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen 1, 2
• Patients should abstain from sexual intercourse until all sex partners are treated 1
• All sex partners from the previous 60 days should be evaluated, tested, and treated 1, 2
• If the last sexual contact was >60 days before diagnosis, the most recent partner should still be treated 1

Follow-Up Recommendations

• Test-of-cure is not recommended for patients treated with the recommended regimens unless therapeutic compliance is questionable, symptoms persist, or reinfection is suspected 1, 2
• Consider retesting women approximately 3 months after treatment due to high risk of reinfection 1, 2

Clinical Considerations

• Treatment failure is uncommon with recommended regimens, with failure rates of 0-3% for males and 0-8% for females 1
• Patient compliance and cost considerations should be taken into account when selecting a treatment, with azithromycin preferred when compliance is a concern and doxycycline generally less expensive 1
• For patients with combined chlamydia and bacterial vaginosis, doxycycline 100 mg orally twice daily for 7 days plus metronidazole 500 mg orally twice daily for 7 days is recommended 4

Treatment Efficacy Considerations

• While both azithromycin and doxycycline are highly effective for urogenital chlamydia, recent evidence suggests doxycycline may be more effective for rectal chlamydia infections 6
• Gastrointestinal side effects with erythromycin often lead to poor compliance, making it a less desirable alternative 1
• Single-dose azithromycin therapy allows for directly observed treatment, which can be beneficial in populations where adherence is a concern 7, 8