Azithromycin Dose for Chlamydia

The recommended dose of azithromycin for treating uncomplicated chlamydial infection is 1 gram orally as a single dose. 1, 2, 3

First-Line Treatment Options

Azithromycin 1 g orally in a single dose is a CDC-recommended first-line treatment with approximately 97% efficacy 2, 3
Doxycycline 100 mg orally twice daily for 7 days is the alternative first-line option with approximately 98% efficacy 2, 3

Single-dose therapy allows for directly observed treatment, which is critical in clinical practice 2, 3
Compliance is significantly better compared to multi-day regimens, making it particularly valuable when adherence is questionable 1, 2
Equally efficacious to doxycycline based on meta-analyses of randomized controlled trials 1, 3
Medications should be dispensed on-site with the first dose directly observed to maximize treatment success 2, 3

If azithromycin or doxycycline cannot be used, alternative options include:

Levofloxacin 500 mg orally once daily for 7 days 1
Ofloxacin 300 mg orally twice daily for 7 days 1
Erythromycin base 500 mg orally four times daily for 7 days (less preferred due to poor compliance from gastrointestinal side effects) 1, 3
Erythromycin ethylsuccinate 800 mg orally four times daily for 7 days 1

Azithromycin 1 g orally in a single dose is the preferred treatment during pregnancy 1, 2
Amoxicillin 500 mg orally three times daily for 7 days is an alternative option 1, 2, 3
Doxycycline, quinolones, and tetracyclines are contraindicated in pregnancy 1, 2

Children ≥8 years who weigh >45 kg: Azithromycin 1 g orally single dose OR doxycycline 100 mg orally twice daily for 7 days 1, 2
Children who weigh >45 kg but <8 years: Azithromycin 1 g orally single dose 1
Children who weigh <45 kg: Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into four doses daily for 14 days 1

Patients must abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen 1, 2, 3
All sex partners from the previous 60 days must be evaluated, tested, and treated to prevent reinfection 2, 3
Test-of-cure is NOT recommended for patients treated with recommended regimens unless compliance is questionable, symptoms persist, or reinfection is suspected 2, 3
Consider retesting women approximately 3 months after treatment due to high reinfection risk (up to 39% in some studies) 2, 3

Failing to provide directly observed therapy when compliance is uncertain leads to treatment failure 2, 3
Not treating sexual partners results in reinfection rates as high as 39% 1
Using erythromycin without counseling about gastrointestinal side effects leads to poor adherence 1, 3
Prescribing doxycycline or quinolones to pregnant patients is contraindicated 1, 2