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J Antimicrob Chemother. 2015 May;70(5):1290-7. doi: 10.1093/jac/dku574. Epub 2015 Jan 29.

The efficacy of azithromycin and doxycycline for the treatment of rectal chlamydia infection: a systematic review and meta-analysis.

Author information

1
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.
2
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.
3
Monash University, Central Clinical School, 580 Swanston St, Melbourne 3053, Australia Melbourne Sexual Health Centre, 580 Swanston St, Melbourne 3053, Australia.
4
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.
5
School of Biomedical Sciences, Queensland University of Technology, 2 George St, Brisbane 4000, Australia.
6
Melbourne Sexual Health Centre, 580 Swanston St, Melbourne 3053, Australia.
7
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie St, Melbourne 3004, Australia.

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.

KEYWORDS:

azithromycin; doxycycline; meta-analysis; rectal chlamydia; treatment efficacy

PMID:
25637520
DOI:
10.1093/jac/dku574
[Indexed for MEDLINE]

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