Is azithromycin suitable for treating Chlamydia
NHS clinical guidelines state that single dose azithromycin, 1g, or doxcycline, 100mg twice daily for 7 days are recommended as equal treatments of choice for uncomplicated Chlamydial infection and for syndromes associated with Chlamydia. However a recent publication by Schwebke et al. challenges the efficacy of azithromycin for Chlamydia Treatment.
It is important not to put too much weight onto a single study, and it would be premature to formally modify management recommendations at this time. All medical studies can result in unexpected outcomes with far-reaching implications and will raise the bar for validation. Despite the study conducted, sample size is very important and the sample size used to test for Azithromycin suitability was modest and restricted to inner-city STI clinics in the South East. The results are not necessarily applicable to other population groups, to women, or to asymptomatic chlamydial infection. The difference in follow-up rates between the treatment arms remains a concern and the study was not designed primarily to assess the efficacy of azitrhomycin.
From a population perspective, does any of this matter very much? Even if azithromycin is less effective than previously believed, wide implementation of these suggestions might have modest impact on overall morbidity and prevention of Chlamydia infection. It is plausibility that the advantages of single-dose therapy would continue to dictate routine use at a cure rate of 90% or lower – itself a potentially important research topic. Nevertheless, the personal health benefits of doxcycline or test cure might be substantial for many patients while we await confirmatory studies.