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Doxycycline slightly more effective than azithromycin for chlamydia
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Data from a meta-analysis suggest that doxycycline might have a small increased efficacy compared with azithromycin for the treatment of urogenital chlamydia.
“In considering whether a change to the treatment guidelines is warranted, readers should consider that over 80% of chlamydia infections are asymptomatic and there are considerable limitations with the quality of available evidence,” researchers from the University of Melbourne, in Australia, wrote in Clinical Infectious Diseases. “Given increasing concern about possible azithromycin treatment failure, further well-designed, double blind, placebo-controlled [randomized controlled trials] are warranted.”
In the analysis, the researchers included 23 studies that compared 1 g azithromycin in a single dose with 100 mg doxycycline given twice daily for 7 days. Within the studies, 1,147 patients were treated with azithromycin and 912 patients were treated with doxycycline. They found that the fixed-effects pooled efficacy difference was 2.6% (95% CI, 0.5-4.7) and the random-effects pooled efficacy difference was 1.5% (95% CI, –0.1 to 3.1). There was a small but significant greater efficacy observed with doxycycline.
In a subgroup analysis, the researchers also found that doxycycline was 7% more effective than azithromycin for the treatment of symptomatic urethral infections in men. None of the studies in the analysis addressed rectal chlamydia infection.
“Given the potential risk of HIV transmission associated with rectal chlamydia infection, it is vital that efficacious treatment is available,” the researchers wrote. “Given these concerns, the European guidelines currently recommend chlamydia rectal infection be treated with 7 days of doxycycline.”
Disclosure: The researchers report no relevant financial disclosures.
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