Chlamydia infection medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2], Aysha Anwar, M.B.B.S[3]

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Overview

The mainstay of therapy for chlamydia is antimicrobial therapy with doxycycline. Recent sex partners (i.e., individuals having sexual contact with the patient within the 60 days preceding onset of symptoms or chlamydia diagnosis) should also be referred for evaluation, testing, and treatment.

Medical Therapy

• Chlamydia infection treatment is recommended for all the persons who test positive to prevent complications.

Antimicrobial Regimen

• 1 Chlamydial infections treatment

• 1.1 Chlamydial Infections in adolescents and adults

• Preferred regimen (1): Doxycycline 100 mg PO bid for 7 days
• Alternative regimen (1): Azithromycin 1 g PO in a single dose
• Alternative regimen (2): Levofloxacin 500 mg PO qd for 7 days
• Alternative regimen (3): Erythromycin base 500 mg PO qid for 7 days
• Alternative regimen (4): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
• Alternative regimen (5): Ofloxacin 300 mg PO bid for 7 days
• Note: Patients should be instructed to refer their sex partners for evaluation, testing, and treatment if they had sexual contact with the patient during the 60 days preceding onset of the patient's symptoms or chlamydia diagnosis. Sex abstinence is recommended for 7 days or till resolution of symptoms

• 1.2 Chlamydial Infections in patients with HIV Infection

• Preferred regimen (1): Doxycycline 100 mg PO bid for 7 days
• Preferred regimen (2): Azithromycin 1 g PO in a single dose
• Preferred regimen (3): Azithromycin 1 g PO in a single dose
• Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
• Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
• Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
• Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days

• 1.3 Pregnancy

• Preferred regimen: Azithromycin 1 g PO in a single dose
• Alternative regimen (1): Amoxicillin 500 mg PO tid for 7 days
• Alternative regimen (2): Erythromycin base 500 mg PO qid for 7 days
• Alternative regimen (3): Erythromycin base 250 mg PO qid for 14 days
• Alternative regimen (4): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
• Alternative regimen (5): Erythromycin ethylsuccinate 400 mg PO qid for 14 days
• Note:Doxycycline, Ofloxacin, and Levofloxacin are contraindicated in pregnant women

• 1.4 Management of sex partners

• Preferred regimen (1): Doxycycline 100 mg PO bid for 7 days
• Preferred regimen (2): Azithromycin 1 g PO in a single dose
• Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
• Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
• Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
• Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days
• Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or Chlamydia diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
• Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
• Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present.

• 2. Chlamydial infection among neonates

• 2.1 Ophthalmia Neonatorum caused by C. trachomatis

• Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/day PO qid for 14 days
• Alternative regimen: Azithromycin suspension 20 mg/kg /day PO qd for 3 days
• Note: The mothers of infants who have chlamydial infection and the sex partners of these women should be evaluated and treated.

• 2.2 Infant Pneumonia

• Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/day PO qid for 14 days
• Alternative regimen: Azithromycin suspension 20 mg/kg /day PO qd for 3 days

• 3.Chlamydial infection among infants and children

• 3.1 Infants and children who weigh < 45 kg

• Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/ day PO qid for 14 days

• 3.2 Infants and children who weigh ≥45 kg but who are aged <8 years

• Preferred regimen: Azithromycin 1 g PO in a single dose

• 3.3 Infants and children aged ≥8 years

• Preferred regimen (1): Azithromycin 1 g PO in a single dose
• Preferred regimen (2): Doxycycline 100 mg PO bid for 7 days

• 4. Lymphogranuloma venereum (LGV)

• Preferred regimen: Doxycycline 100 mg PO bid for 21 days
• Alternative regimen: Erythromycin base 500 mg PO qid for 21 days
• Note (1): Azithromycin 1 g PO once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.
• Note (2): Pregnant and lactating women should be treated with Erythromycin. Azithromycin might prove useful for treatment of LGV in pregnancy, but no published data is available regarding its safety and efficacy. Doxycycline is contraindicated in pregnant women.
• Note (3): Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.
• Note (4): Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined and tested for urethral, cervical, or rectal chlamydial infection depending on anatomic site of exposure. They should be presumptively treated with a chlamydia regimen ( Azithromycin 1 g PO single dose OR Doxycycline 100 mg PO bid for 7 days).

Follow-up guidelines

• Resting for positive cases after 3 months of treatment
• Resting within 12 months after treatment if patient fails to follow up in 3 months period.
• Infants with ophthalmia neonatorum needs a follow up testing as treatment efficacy erythromycin is not more than 80%.
• In sexual abuse of children and adults, repeat testing should be performed after 2 weeks of treatment.
• All pregnant women diagnosed with chlamydia infection should be retested 3-4 weeks after treatment.
• All pregnant women are retested 3 months after initial infection.

References

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