Infectious Disease

7-day doxycycline therapy could be a new “first-line” treatment for rectal chlamydia in MSM. be

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Hocking does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

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Studies found that a week’s treatment with doxycycline was superior to a single dose of azithromycin for treating rectal chlamydia in men who have sex with men or MSM.

The randomized, double-blind study, published in the New England Journal of Medicine, enrolled 625 men from five clinics in Australia.

Hocking pull quota

“Our results suggest that doxycycline should replace azithromycin as the first-line treatment for rectal chlamydia. Doctors should use doxycycline as a first-line treatment for chlamydial infection at any site of infection – including genitourinary and rectal infections, especially since most women with urogenital infections also have rectal chlamydia. ” Jane Hocking, MPH, PhD, NHMRC Fellow at Melbourne School of Population and Global Health, said Healio. “However, azithromycin will continue to have a place in the treatment of chlamydial infection in pregnant women who are contraindicated to doxycycline, those who are allergic to doxycycline, and those who have serious concerns about adhering to 7-day therapy.”

Hocking and colleagues randomly assigned 314 of the men 100 mg doxycycline twice daily for 7 days and 311 of the men a 1 g single dose of azithromycin. They assessed whether the participants were cured of chlamydia after 4 weeks using the nucleic acid amplification test (NAAT).

After 4 weeks, test results were available for 290 (92.4%) of the men who received doxycycline and 297 (95.5%) of the men who received azithromycin. According to the researchers, 96.9% (n = 281/290; 95% CI, 94.9% -98.9%) of the men in the doxycycline group and 76.4% (n = 227/297; 95%) -KI, 73.8% – 79.1%) of the men in the azithromycin group were cured.

Hocking said one of the main limitations of the study was that it only included MSM.

“However, the burden on the rectal chlamydial organism is similar between the sexes, and observational data show similar treatment efficacy in men and women – suggesting that our results also apply to women,” said Hocking. “Only men with asymptomatic chlamydia were eligible, but since over 85% of rectal chlamydia in men are asymptomatic, our results apply to the majority of patients with an infection.”

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Carlos del Rio, MD, MD)

Carlos del Rio, MD

The study by Lau and colleagues of Melbourne, Australia, is an important randomized controlled trial that will undoubtedly influence treatment guidelines for sexually transmitted diseases. Current CDC guidelines recommend doxycycline or azithromycin as the first line treatment for rectal chlamydial infection. However, observational data suggest that doxycycline is more effective than azithromycin.

The results of this study are similar to those of a smaller study recently published in Clinical Infectious Diseases that showed microbiological cure in 100% of those given doxycycline and 74% of those given azithromycin. I think these two studies conclusively prove that a week of doxycycline is more effective than a single dose of azithromycin for treatment.

Reference:

Dombrowski JC et al. Clin Infect Dis. 2021; doi: 10.1093 / cid / ciab153.

Carlos del Rio, MD

Member of the editorial board of Infectious Disease News

Excellent professor of medicine

Executive Associate Dean

Emory University School of Medicine

Disclosure: Del Rio does not report any relevant financial information.

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