Summarization of doxycycline for treatment of chlamydia
Changing treatment recommendations for Chlamydia trachomatis from single dose azithromycin to 7 days of treatment with doxycycline has opened the door of adherence concerns for young adult and adolescent care providers. While azithromycin remains an option for treatment of chlamydia infections in patients who are pregnant, have severe concerns for adherence challenges, or prescription pick-up issues, consider doxycycline as the first line of treatment in terms of effectiveness for chlamydia treatment.
Kong et. al. (2014) and Paez-Canro et. al., (2019) evaluated data from randomized clinical trials comparing azithromycin to doxycycline for treating urogenital chlamydial infection and found that microbiologic treatment failure among men was higher when azithromycin was prescribed for treatment versus doxycycline. Additionally, both observational and randomized control trial studies have demonstrated that doxycycline is more effective for rectal C. trachomatis infection for men (microbiologic cure of 100%) and women (microbiologic cure of 74%) than azithromycin (Workowski et.al., 2021).
Available evidence supports that doxycycline is efficacious for C. trachomatis infections of urogenital, rectal, and oropharyngeal sites. Although azithromycin maintains high efficacy for urogenital chlamydia in women, concern exists regarding effectiveness of azithromycin for concomitant rectal infection, which can occur commonly among women and cannot be predicted by reported sexual activity (Workowski et. al., 2021). Inadequately treated rectal chlamydia infection among women who have urogenital infection can increase the risk for transmission and place women at risk for repeat urogenital chlamydia through autoinoculation from the anorectal site (Rank & Yeruza, 2015).
Workowski et. al. (2021) suggest that when nonadherence to doxycycline regimen is a substantial concern, utilization of the azithromycin 1 g regimen might require posttreatment evaluation and testing because it has demonstrated lower treatment efficacy among persons with rectal infection.
Kong, F., Tabrizi, S., Law, M., et. al. (2014). Azithromycin versus doxycycline for the treatment of genital chlamydia infection: a meta-analysis of randomized controlled trials. Clin Infect Dis, 59:193-205. PMID:24729507 https://doi.org/10.1093/cid/ciu220
Paez-Canro, C., Alzate, J., Gonzalez, L., Rubio-Romero, J., Lethaby, A., Gaitan, H. (2019). Antibiotics for treating urogenital chlamydia trachomatis infection in men and non-pregnant women. Cochrane Database Syst Rev, 1:CD010871. PMID:30682211 https://doi.org/10.1002/14651858.CD010871.pub2
Rank, R., Yeruza, L. (2015). An alternative scenario to explain rectal positivity in chlamydia-infected indifiduals. ClinInfect Dis, 60, 1585-1586. PMID:25648236 https://doi.org/10.1093/cid/civ079
Workowski, K., Bachmann, L., Chan, P., et al. (2021). Sexually transmitted infections treatment guidelines. MMWR Recomm Rep, 70, (No. 4), 65-68
These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.