What is the recommended treatment for chlamydia?

Treatment for Chlamydia

The recommended first-line treatment for uncomplicated chlamydial infection is either azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days, with efficacy rates of approximately 97% and 98%, respectively. 1, 2

First-Line Treatment Options

• Azithromycin 1 g orally in a single dose offers the advantage of directly observed therapy, ensuring compliance, making it particularly useful when adherence to multi-day regimens is questionable 1, 3
• Doxycycline 100 mg orally twice daily for 7 days has slightly higher efficacy (98%) and is generally less expensive than azithromycin 1, 4
• Both medications have similar rates of mild-to-moderate side effects, primarily gastrointestinal symptoms 3

Alternative Treatment Options

• Erythromycin base 500 mg orally four times a day for 7 days 1, 5
• Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days 1, 5
• Ofloxacin 300 mg orally twice a day for 7 days 1, 6
• Levofloxacin 500 mg orally once daily for 7 days 2

Treatment During Pregnancy

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

Implementation Recommendations

• Medications should be dispensed on-site when possible, with the first dose directly observed to maximize compliance 1, 2
• Patients should abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen 1
• All sex partners from the previous 60 days should be evaluated, tested, and treated to prevent reinfection 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, 7
• Treatment failure is uncommon with recommended regimens, with failure rates of 0-3% for males and 0-8% for females 1

Clinical Considerations and Pitfalls

• Erythromycin often causes gastrointestinal side effects that lead to poor compliance, making it a less desirable alternative 1, 5
• Patient compliance and cost considerations should be taken into account when selecting a treatment 1, 8
• Failure to ensure partner treatment significantly increases the risk of reinfection 8
• Persistent or recurrent infection may be due to reinfection rather than treatment failure, particularly in younger patients or those with new or multiple partners 8, 9

Special Populations

• For children ≥8 years who weigh >45 kg, use adult dosing; for children ≥8 years who weigh <45 kg, treatment should be based on weight 2
• Patients with HIV should receive the same treatment regimens as those who are HIV-negative 2, 7