Questioning azithromycin for chlamydial infection.

摘要

Single dose azithromycin, 1.0 g, or doxycycline, 100 mg twice daily for 7 days, are recommended as equal treatments of choice for uncomplicated chlamydial infection, and for syndromes associated with Chlamydia trachomatis, such as nongonococcal urethritis (NGU) and mucopurulent cervicitis (MPC) in young women.1 However, a recent publication challenges the efficacy of azithromycin against chlamydial infection. Schwebke et al. conducted a multicenter randomized controlled trial (RCT) of the treatment of NGU in relation to Mycoplasma genitalium and Trichomonas vaginalis.2 Men with symptomatic NGU (N = 305) attending sexually transmitted disease (STD) clinics in 4 cities in the southeastern United States were randomized to treatment with the recommended regimens of azithromycin or doxycycline, with or without tinidazole in a single dose of 2.0 g. All 4 regimens had similar clinical efficacy. Tinidazole eradicated T. vaginalis but made no difference in clinical resolution of urethritis, and M. genitalium was better eradicated by azithromycin than doxycycline, although neither drug was highly effective (67% vs 31%). The study also found that C. trachomatis was eradicated in only 41 (77%) of 53 men given azithromycin, compared with 55 (95%) of 58 patients treated with doxycycline (P = 0.011).