From the Guidelines
Chlamydia should be treated with a single 1-gram dose of azithromycin taken orally, or doxycycline 100mg taken orally twice daily for 7 days, as recommended by the Centers for Disease Control and Prevention (CDC) 1. The first-line treatment for chlamydia is azithromycin, which is preferred for pregnant women as doxycycline is contraindicated during pregnancy. Alternative treatments include erythromycin 500mg orally four times daily for 7 days, or levofloxacin 500mg orally once daily for 7 days. Some key points to consider when treating chlamydia include:
- Abstaining from sexual activity for 7 days after treatment completion and until all partners have been treated to prevent reinfection 1
- Notifying, testing, and treating all sexual partners from the past 60 days
- Retesting 3 months after treatment due to high reinfection rates, except in pregnancy where a test-of-cure is recommended
- Ensuring that medications for chlamydial infections are dispensed on site, and the first dose is directly observed to maximize compliance with recommended therapies 1 Chlamydia responds well to antibiotics because the bacterium, Chlamydia trachomatis, is susceptible to drugs that interfere with protein synthesis or DNA replication. Untreated infections can lead to pelvic inflammatory disease, infertility, and increased risk of HIV transmission, making prompt treatment essential.
From the FDA Drug Label
For adults with uncomplicated urethral, endocervical, or rectal infections caused by Chlamydia trachomatis, when tetracycline is contraindicated or not tolerated 500 mg of erythromycin by mouth four times a day for at least 7 days. Urogenital Infections During Pregnancy Due to Chlamydia trachomatis Although the optimal dose and duration of therapy have not been established, the suggested treatment is 500 mg of erythromycin by mouth four times a day on an empty stomach for at least 7 days The treatment for chlamydia with erythromycin is 500 mg by mouth four times a day for at least 7 days 2.
- The dosage may vary depending on the patient's condition and tolerance.
- For pregnant women, the suggested treatment is the same, but with the option to decrease the dose to 250 mg by mouth four times a day or 500 mg every 12 hours for at least 14 days if the patient cannot tolerate the initial regimen 2.
From the Research
Treatment Options for Chlamydia
- Azithromycin and doxycycline are two commonly recommended treatments for chlamydia, with azithromycin typically given as a single 1-g dose and doxycycline given as 100 mg twice daily for 7 days 3, 4, 5, 6, 7.
- The efficacy of these treatments can vary depending on the population being treated and the specific strain of chlamydia 6, 7.
Efficacy of Azithromycin vs. Doxycycline
- A randomized controlled trial found that doxycycline was more effective than azithromycin for the treatment of rectal chlamydia in men who have sex with men, with a microbiologic cure rate of 100% vs. 74% 6.
- A systematic review found that azithromycin was probably less effective than doxycycline for microbiological failure in men, but may have little difference in clinical failure 7.
- Another study found that azithromycin was as safe and efficacious as doxycycline for the treatment of uncomplicated genital chlamydial infection in adolescents 5.
Safety and Adverse Events
- Azithromycin and doxycycline have similar safety profiles, with mild to moderate gastrointestinal adverse events being the most common side effects 4, 5, 7.
- A systematic review found that azithromycin probably slightly reduces adverse events compared to doxycycline in men and women together, but may have little difference in men alone 7.
Pharmacoeconomic Considerations
- A pharmacoeconomic review found that azithromycin was more costly than doxycycline, but may be more effective in terms of patient compliance and treatment outcomes 4.
- The cost-effectiveness of azithromycin vs. doxycycline can vary depending on the specific population being treated and the healthcare system in question 4.