From the Guidelines
Azithromycin is typically given as a single 1-gram (1000 mg) oral dose for the treatment of many sexually transmitted infections (STIs), particularly chlamydia, as recommended by the most recent guidelines 1.
Key Considerations
- The single-dose regimen of azithromycin has the advantage of improved compliance and directly observed therapy, ensuring treatment completion.
- For gonorrhea, azithromycin is no longer recommended as monotherapy due to increasing resistance, but may be used as part of dual therapy with ceftriaxone, as suggested by the Centers for Disease Control and Prevention 1.
- Patients should abstain from sexual activity for 7 days after treatment and ensure their partners are treated to prevent reinfection.
Mechanism of Action and Side Effects
- Azithromycin works by binding to the 50S ribosomal subunit of susceptible bacteria, inhibiting protein synthesis.
- Common side effects include gastrointestinal disturbances like nausea, diarrhea, and abdominal pain, which can be reduced by taking the medication with food, although this may slightly decrease absorption.
Treatment Guidelines
- The recommended regimens for non-gonococcal urethritis include azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice a day for 7 days, as outlined in the guidelines 1.
- Patients should be instructed to return for evaluation if symptoms persist or recur after completion of therapy, and should refer all sex partners within the preceding 60 days for evaluation and treatment.
From the Research
Azithromycin Treatment Duration for Sexually Transmitted Infections (STIs)
- The recommended duration of azithromycin treatment for STIs is typically a single dose of 1 g, as seen in the treatment of uncomplicated genital chlamydial infections 2.
- A single 1 g dose of azithromycin has been shown to be as effective as a 7-day regimen of doxycycline in eradicating Chlamydia trachomatis 3, 2.
- For the treatment of gonorrhea, a single 2 g dose of azithromycin has been used, but the effectiveness of this treatment is not as well established as the 1 g dose for chlamydial infections 4.
- The 2021 CDC guidelines do not specify the use of azithromycin as a first-line treatment for gonorrhea, instead recommending ceftriaxone monotherapy 5.
- A test-of-cure is recommended for all cases of pharyngeal gonorrhea and for rectal chlamydia if treated with azithromycin, indicating that the treatment duration may need to be adjusted based on the specific infection and patient response 5.