Drug Update: Chlamydia trachomatis - Brief Article - Statistical Data Included

Family Pratice News,  Jan 1, 2000  by Mitchel L. Zoler,  Miriam E. Tucker

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All sexually active women aged 15-24 should be screened for genital infection with Chlamydia trachomatis at least yearly. Prevalence in this group ranges from 1% 2% in some parts of the country to 15%-18% in others. Some experts advise screening every 6 months in high prevalence areas.

Older women who are sexually active with multiple partners and adolescent and young adult males should also be screened periodically. This has been made easier in the last year with the availability of urine screens.

Treatment is fairly straightforward. There are two equally effective, first-line rugs for nonpregnant patients: azithromycin is given as a single dose; doxycycline is much cheaper. Other treatment options are generally considered second-line alternatives.

The recommended drugs and dosages are the same for postpubescent patients of all ages, both females and males.

For pregnant patients, doxycycline and ofloxacin are contraindicated. Azithromycin is widely used to treat pregnant women even though it is not approved for use during pregnancy.

DRUG              DOSAGE        COST/TREATMENT [*]
azithromycin      1 g orally,   $20.35 (powder)
 (Zithromax)      single dose
doxycycline       100 mg orally $7.56
                  b.i.d. for 7
                  days
erythromycin base 500 mg orally $6.72
                  q.i.d. for 7
                  days
erythromycin      800 mg orally $15.12
 ethylsuccinate   q.i.d. for 7
                  days
ofloxacin         300 mg orally $62.44
 (Floxin)         b.i.d. for 7
                  days
amoxicillin       500 mg orally $7.56
                  t.i.d. for 7
                  days
DRUG              COMMENT [**]
azithromycin      Considered first-line because of its ease of
 (Zithromax)      use and assured compliance if ingestion is
                  directly oberved. Gastrointestinal side effects
                  occur occasionally but are generally well
                  tolerated. Not approved for use in pregnancy,
                  but many physicians prescribe it to pregnant
                  women anyway because there are no specific
                  contraindications and few good alternatives
                  exist. Cost is the major downside.
doxycycline       As effective as azithromycin, but many more
                  doses needed, making compliance much harder to
                  ensure. Low cost is the major advantage. Some
                  data suggest that fewer than 7 days might be
                  enough to eradicate chlamydia, but for now few
                  experts recommend this. Can cause occasional GI
                  problems and photosensitivity. Good choice if
                  is allergic to azithromycin or cost is an
                  issue. Contraindicated during pregnancy.
erythromycin base Generally not recommended because it is less
                  effective and causes more GI symptoms than the
                  top-tier drugs. Can be used during pregnancy.
                  effective and causes more GI symptoms than the
                  top-tier drugs. Can be used during pregnancy.
erythromycin      Generally not recommended because it is less
 ethylsuccinate   effective and causes more GI symptoms than the
                  top-tier drugs. Can be used during pregnancy.
ofloxacin         As effective as, but no better than,
 (Floxin)         azithromycin, or doxycycline. High cost exceeds
                  even azithromycin, and ofloxacin needs the week
                  -long dosing schedule of doxycycline.
                  Contraindicated during pregnancy.
amoxicillin       Not recommended in nonpregnant patients.
                  Despite classification as a "recommended
                  regimen" for chlamydia in pragnant women by the
                  Centers for Disease Control and Prevention, it
                  has no advantages over other drugs that are not
                  contraindicated during pregnancy.
(*.)Cost is based on the average wholesaleprice for a 100 unit container,
or closest available size, of the generic formulation, unless otherwise
indicated, in the 1999 Red Book.
(**.)The comments reflect the viewpoints and expertise of the following
sources:
Dr. Alain Joffe, director of adolescent medicine, Johns Hopkins University,
Baltimore.
Or. Walter E. Stamm, professor of medicine and head of the division of
allergy and infectious diseases at the University of Washington, Seattle.
Dr. Harold C. Wiesenfeld, codirector, STD Program, Allegheny County (Pa.)
Health Department.

COPYRIGHT 2000 International Medical News Group
COPYRIGHT 2001 Gale Group