Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials.
BACKGROUND
Azithromycin and doxycycline are recommended for treatment of genital Chlamydia trachomatis infection. A systematic review comparing these antibiotics could affect treatment guidelines.


OBJECTIVE
The goal was to perform a meta-analysis to evaluate the efficacy and tolerance of azithromycin versus doxycycline for genital chlamydial infection.


METHODS
Studies were identified by searching computerized English-language databases for the period 1975 to August 2001, supplemented by a manual bibliographic search. Criteria for inclusion were (1) randomized trial design; (2) regimens of oral doxycycline (100 mg twice daily for 7 days) and oral azithromycin (1 g once); (3) males >15 years of age and nonpregnant females >15 years of age; (4) and evaluation of microbial cure at follow-up. Data were extracted on diagnostic assay, follow-up time, study design, sponsorship, patients' characteristics, adverse events, attrition rates, and outcomes.


RESULTS
Twelve trials met the inclusion criteria; 1543 patients were evaluated for microbial cure and 2171 for adverse events. 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 difference for microbial cure (0.01; 95% CI, -0.01-0.02) and the risk difference for adverse events (0.01; 95% CI, -0.02-0.04) between the two drugs were not statistically significant.


CONCLUSIONS
Azithromycin and doxycycline are equally efficacious in achieving microbial cure and have similar tolerability. Further head-to-head trials comparing these antibiotics are unnecessary.
Lau
Chuen-Yen
CY
Cedars Sinai Medical Center, Department of Internal Medicine, Los Angeles, California 90048, USA. laucy@cshs.org
Qureshi
Azhar K
AK
D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017963:Azithromycin / Q000009:adverse effects / Q000627:therapeutic use*; D002690:Chlamydia Infections / Q000188:drug therapy / Q000382:microbiology; D002692:Chlamydia trachomatis; D004318:Doxycycline / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014526:Urethritis / Q000188:drug therapy* / Q000382:microbiology; D002575:Uterine Cervicitis / Q000188:drug therapy* / Q000382:microbiology
D000900:Anti-Bacterial Agents; D017963:Azithromycin; D004318:Doxycycline