Doxycycline and azithromycin for prevention of chlamydial persistence or recurrence one month after treatment in women. A use-effectiveness study in public health settings.
BACKGROUND
To treat chlamydial infection, the Centers for Disease Control and Prevention recommends either a single dose of azithromycin or a 7-day course of doxycycline. Cost is a concern with the single-dose regimen; compliance is a concern with the multidose regimen.


OBJECTIVE
To compare the use-effectiveness of azithromycin and doxycycline for preventing persistence or recurrence of Chlamydia trachomatis infection in women and to evaluate associated risk behaviors.


METHODS
One hundred and ninety-six chlamydia-infected women and their sex partners were recruited into a randomized controlled trial of single-dose versus multidose regimens in seven public health clinics, with no incentives for enrollment, compliance, or follow-up. The outcome, measure was a positive test for C. trachomatis by polymerase chain reaction testing at 1 month after treatment.


RESULTS
C. trachomatis positivity at 1 month was similar for women receiving single-dose (5.1%, 5/98) and multidose therapy (4.1%, 4/98). Reported compliance among 73 women taking multidose therapy was 94.5%. A twofold to threefold increased risk of chlamydial persistence or recurrence was observed among women who were < or = 24 and white or who reported: a recent new partner, multiple partners, or a partner who may have had multiple partners at the time of enrollment or that not all partners were treated during the 1-month follow-up period after initiation of treatment.


CONCLUSIONS
The use-effectiveness of single-dose and multidose therapy was comparably high. Observed rates of persistence or recurrence were consistent with reported rates of pharmacological treatment failure. However, all women with C. trachomatis detected at 1 month had behavioral risk factors that may have contributed to reinfection.
Hillis
S D
SD
Division of Reproductive Health, National Center for Chronic Disease Prevention, Atlanta, GA 30333, USA.
Coles
F B
FB
Litchfield
B
B
Black
C M
CM
Mojica
B
B
Schmitt
K
K
St Louis
M E
ME
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D002690:Chlamydia Infections / Q000517:prevention & control*; D002692:Chlamydia trachomatis; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D011634:Public Health; D012008:Recurrence
D000900:Anti-Bacterial Agents; D017963:Azithromycin; D004318:Doxycycline