Treatment treating persons infected with c

Treatment
Treating persons infected with C. trachomatis prevents
adverse reproductive health complications and continued
sexual transmission, and treating their sex partners can prevent
reinfection and infection of other partners. Treating pregnant
women usually prevents transmission of C. trachomatis to
neonates during birth. Chlamydia treatment should be
provided promptly for all persons testing positive for infection;
treatment delays have been associated with complications (e.g.,
PID) in a limited proportion of women ( 513 ).
Recommended Regimens
Azithromycin 1 g orally in a single dose
OR
Doxycycline 100 mg orally twice a day for 7 days
Alternative Regimens
Erythromycin base 500 mg orally four times a day for 7 days
OR
Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days
OR
Levofloxacin 500 mg orally once daily for 7 days
OR
Ofloxacin 300 mg orally twice a day for 7 days
A meta-analysis of 12 randomized clinical trials of
azithromycin versus doxycycline for the treatment of urogenital
chlamydial infection demonstrated that the treatments were
equally efficacious, with microbial cure rates of 97% and 98%,
respectively ( 514 ). These studies were conducted primarily
in populations with urethral and cervical infection in which
follow-up was encouraged, adherence to a 7-day regimen was
effective, and culture or EIA (rather than the more sensitive
NAAT) was used for determining microbiological outcome.
More recent retrospective studies have raised concern about
the efficacy of azithromycin for rectal C. trachomatis infection
( 515,516 ), however, these studies have limitations, and
prospective clinical trials comparing azithromycin versus
doxycycline regimens for rectal C. trachomatis infection
are needed.
Although the clinical significance of oropharyngeal
C. trachomatis infection is unclear and routine oropharyngeal
screening for CT is not recommended, available evidence
suggests oropharyngeal C. trachomatis can be sexually
transmitted to genital sites ( 152,517 ); therefore, detection
of C. trachomatis from an oropharyngeal specimen should
be treated with azithromycin or doxycycline. The efficacy of
alternative antimicrobial regimens in resolving oropharyngeal
chlamydia remains unknown.

Recommendations and Reports
MMWR / June 5, 2015 / Vol. 64 / No. 3 57
In a double-blinded randomized control trial, a doxycycline
delayed-release 200 mg tablet administered daily for 7 days was
as effective as generic doxycycline 100 mg twice daily for 7 days
for treatment of urogenital C. trachomatis infection in men
and women and had a lower frequency of gastrointestinal side
effects. However, this regimen is more costly than those that
involve multiple daily doses ( 518 ). Delayed-release doxycycline
(Doryx) 200 mg daily for 7 days might be an alternative
regimen to the doxycycline 100 mg twice daily for 7 days for
treatment of urogenital C. trachomatis infection. Erythromycin
might be less efficacious than either azithromycin or
doxycycline, mainly because of the frequent occurrence of
gastrointestinal side effects that can lead to nonadherence