title: The efficacy of azithromycin and doxycycline for the treatment of rectal chlamydia infection: a systematic review and meta-analysis.
abstract: BACKGROUND
  There are increasing concerns about treatment failure following treatment for rectal chlamydia with 1 g of azithromycin. A systematic review and meta-analysis was conducted to investigate the efficacy of 1 g of azithromycin as a single dose or 100 mg of doxycycline twice daily for 7 days for the treatment of rectal chlamydia.
  
  
  METHODS
  Medline, Embase, PubMed, Cochrane Controlled Trials Register, Australia New Zealand Clinical Trial Register and ClinicalTrials.gov were searched to the end of April 2014. Studies using 1 g of azithromycin or 7 days of doxycycline for the treatment of rectal chlamydia were eligible. Gender, diagnostic test, serovar, symptomatic status, other sexually transmitted infections, follow-up time, attrition and microbial cure were extracted. Meta-analysis was used to calculate pooled (i) azithromycin and doxycycline efficacy and (ii) efficacy difference.
  
  
  RESULTS
  All eight included studies were observational. The random-effects pooled efficacy for azithromycin (based on eight studies) was 82.9% (95% CI 76.0%-89.8%; I(2) = 71.0%; P < 0.01) and for doxycycline (based on five studies) was 99.6% (95% CI 98.6%-100%; I(2) = 0%; P = 0.571), resulting in a random-effects pooled efficacy difference (based on five studies) of 19.9% (95% CI 11.4%-28.3%; I(2) = 48.5%; P = 0.101) in favour of doxycycline.
  
  
  CONCLUSIONS
  The efficacy of single-dose azithromycin may be considerably lower than 1 week of doxycycline for treating rectal chlamydia. However, the available evidence is very poor. Robust randomized controlled trials are urgently required.
authors: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie St, Melbourne 3004, Australia kongf@unimelb.edu.au.
authors: Fabian Yuh Shiong
authors: FY
authors: Kong
authors: Murdoch Children's Research Institute, 50 Flemington Rd, Parkville 3052, Australia Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, 20 Flemington Road, Parkville 3052, Australia.
authors: Sepehr N
authors: SN
authors: Tabrizi
authors: Monash University, Central Clinical School, 580 Swanston St, Melbourne 3053, Australia Melbourne Sexual Health Centre, 580 Swanston St, Melbourne 3053, Australia.
authors: Christopher Kincaid
authors: CK
authors: Fairley
authors: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie St, Melbourne 3004, Australia Murdoch Children's Research Institute, 50 Flemington Rd, Parkville 3052, Australia Melbourne Sexual Health Centre, 580 Swanston St, Melbourne 3053, Australia.
authors: Lenka A
authors: LA
authors: Vodstrcil
authors: School of Biomedical Sciences, Queensland University of Technology, 2 George St, Brisbane 4000, Australia.
authors: Wilhelmina M
authors: WM
authors: Huston
authors: Melbourne Sexual Health Centre, 580 Swanston St, Melbourne 3053, Australia.
authors: Marcus
authors: M
authors: Chen
authors: Melbourne Sexual Health Centre, 580 Swanston St, Melbourne 3053, Australia.
authors: Catriona
authors: C
authors: Bradshaw
authors: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie St, Melbourne 3004, Australia.
authors: Jane S
authors: JS
authors: Hocking
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017963:Azithromycin / Q000008:administration & dosage*; D002689:Chlamydia / Q000187:drug effects*; D002690:Chlamydia Infections / Q000188:drug therapy*; D004318:Doxycycline / Q000008:administration & dosage*; D006801:Humans; D064887:Observational Studies as Topic; D012002:Rectal Diseases / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin; D004318:Doxycycline
keywords: azithromycin; doxycycline; meta-analysis; rectal chlamydia; treatment efficacy