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Evidence summaries

Azithromycin and Doxycycline for Uncomplicated Genital Chlamydial Infection

Azithromycin and doxycycline are effective for genital chlamydial infection. Single-dose azithromycin 1 g is as effective as doxycycline 100 mg twice daily for 7 days for uncomplicated genital chlamydial infection. Level of evidence: "A"

A Cochrane review 10871[Abstract] 3 included 14 studies with a total of 2715 subjects (79% men). For the comparison: azithromycin single dose versus doxycycline once or twice daily for 7 days, in men the risk of microbiological failure was higher in the azithromycin group (table T1), but regarding clinical failure, the results showed that the effect is uncertain.

Azithromycin 1 g single dose vs doxycycline 100 mg twice a day for 7 days for genital C trachomatis

OutcomesRelative effect (95% CI)Risk with doxycyclineRisk with azithromycin (95% CI)of participants (studies)
Microbiological failure MenRR 2.45 (1.36 to 4.41)33 per 100081 per 1000 (45 to 146)821 (9 )
Microbiological failure WomenRR 1.71 (0.48 to 6.16)12 per 100021 per 1000 (6 to 77)338 (5)
Clinical failure MenRR 0.94 (0.43 to 2.05)123 per 1000116 per 1000 (53 to 252)525 (3)
Adverse eventsMen and womenRR 0.83 (0.71 to 0.98)183 per 1000149 per 1000 (130 to 180)2261 (9)

A meta-analysis 2 assessing azithromycin (1 g once) versus doxycycline (100 mg twice daily for 7 days) for genital chlamydial infections included 12 RCTs with a total of 1543 males and nonpregnant females. Cure rates were 97% for azithromycin and 98% for doxycycline. Adverse events occurred in 25% and 23% of patients treated with azithromycin and doxycycline, respectively. After pooling of the data, differences in efficacy and risk were computed. The efficacy and risk of adverse events between the two drugs were not statistically significant.

A topic in Clinical Evidence 1 summarizes the results of one systematic review (search date 2001, 12 blinded and unblinded RCTs, 1543 people). Azithromycin 1 g as a single dose was as effective as doxycycline 100 mg twice daily for 7 days (cure rates for azithromycin 81-100%, doxycycline 92-100%, pooled efficacy difference +0.008, 95% CI -0.007 to +0.022).

    References

    • Low N. What are the effects of antibiotic treatment in men and non-pregnant women with uncomplicated genital chlamydial infection. Clinical Evidence 2005;13:1981-1986.
    • Lau CY, Qureshi AK. Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials. Sex Transm Dis 2002;29(9):497-502. [PubMed]
    • Páez-Canro C, Alzate JP, González LM et al. Antibiotics for treating urogenital Chlamydia trachomatis infection in men and non-pregnant women. Cochrane Database Syst Rev 2019;(1):CD010871.[PubMed]

Primary/Secondary Keywords