title: Compliance with doxycycline therapy in sexually transmitted diseases clinics.
abstract: OBJECTIVE
  To determine rates of compliance with doxycycline therapy for patients attending two inner city sexually transmitted diseases (STD) clinics using the MEMS (Medication Event Monitoring System) technology (Aprex Corporation, Fremont, CA).
  
  
  METHODS
  An observational study.
  
  
  METHODS
  Two STD clinics in Brooklyn, New York and Birmingham, Alabama.
  
  
  METHODS
  Patients warranting doxycycline as antichlamydial therapy by usual clinical criteria (e.g., documented chlamydial infections, gonococcal urethritis, mucopurulent cervicitis) were enrolled consecutively from both clinics into four separate categories according to gender and the presence or absence of symptoms: symptomatic men (77), asymptomatic men (30), symptomatic women (83), asymptomatic women (33).
  
  
  METHODS
  In the clinic area, patients were given their doxycycline in standard 30-dram medication bottles fitted with the MEMS cap, which is capable of recording the date and time of each bottle opening and closing. This information was then retrieved using a software program developed by the manufacturer. Patients were instructed to return the bottle and cap at the completion of therapy. Efforts were made to contact those who did not return their bottles by both telephone and mail.
  
  
  METHODS
  Bottle openings as recorded by the MEMS were considered to represent use of medication. Patients were considered strictly compliant with prescription instructions if bottle openings and closings occurred at least twice daily for 6 consecutive days. Noncompliance was defined as initially opening the medication more than 48 hours after leaving the clinic or opening the bottle less than once daily for 5 consecutive days. Usage between these extremes was classified as intermediate.
  
  
  RESULTS
  Eighty percent of 223 patients enrolled completed the study by returning their bottles. The rate of strict compliance with prescription instruction was 25%. The rate of noncompliance was 24%. Fifty-one percent used some intermediate amount of medication. There was no statistical difference in compliance by gender, presence or absence of symptoms, or site of enrollment.
  
  
  CONCLUSIONS
  Few patients administered doxycycline in an STD clinic can be expected to take medication precisely as prescribed. Although most probably take enough to eradicate uncomplicated chlamydial infections, a sizable portion can be expected to use an inadequate amount of medication. This may contribute to persistence of genital chlamydia infections in the community.
authors.affiliation: Department of Medicine, SUNY-Health Science Center at Brooklyn 11203, USA.
authors.forename: M
authors.initials: M
authors.lastname: Augenbraun
authors.forename: L
authors.initials: L
authors.lastname: Bachmann
authors.forename: T
authors.initials: T
authors.lastname: Wallace
authors.forename: L
authors.initials: L
authors.lastname: Dubouchet
authors.forename: W
authors.initials: W
authors.lastname: McCormack
authors.forename: E W
authors.initials: EW
authors.lastname: Hook
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002690:Chlamydia Infections / Q000188:drug therapy*; D002692:Chlamydia trachomatis; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline