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BMC Infect Dis. 2015 Apr 30;15:200. doi: 10.1186/s12879-015-0939-3.

Is it time to switch to doxycycline from azithromycin for treating genital chlamydial infections in women? Modelling the impact of autoinoculation from the gastrointestinal tract to the genital tract.

Author information

1
The Kirby Institute, UNSW Australia, Sydney, NSW, 2052, Australia. acraig@kirby.unsw.edu.au.
2
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, 3004, Australia. kongf@unimelb.edu.au.
3
University of Arkansas for Medical Sciences & Arkansas Children's Hospital Research Institute, Little Rock, AR, 72202, USA. VLYeruva@uams.edu.
4
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, 3004, Australia. j.hocking@unimelb.edu.au.
5
University of Arkansas for Medical Sciences & Arkansas Children's Hospital Research Institute, Little Rock, AR, 72202, USA. RankRogerG@uams.edu.
6
The Kirby Institute, UNSW Australia, Sydney, NSW, 2052, Australia. dwilson@unsw.edu.au.
7
The Kirby Institute, UNSW Australia, Sydney, NSW, 2052, Australia. bdonovan@kirby.unsw.edu.au.
8
Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, 2000, Australia. bdonovan@kirby.unsw.edu.au.

Abstract

BACKGROUND:

Single-dose azithromycin is recommended over multi-dose doxycycline as treatment for chlamydial infection. However, even with imperfect adherence, doxycycline is more effective in treating genital and rectal infection. Recently, it has been suggested that autoinoculation from the rectum to the genitals may be a source of persistent chlamydial infection in women. We estimated the impact autoinoculation may have on azithromycin and doxycycline effectiveness.

METHODS:

We estimate treatment effectiveness using a simple mathematical model, incorporating data on azithromycin and doxycycline efficacy from recent meta-analyses, and data on prevalence of rectal infection in women with genital chlamydial infection.

RESULTS:

When the possibility of autoinoculation is taken into account, we calculate that doxycycline effectiveness may be 97% compared to just 82% for azithromycin.

CONCLUSIONS:

Consideration should be given to re-evaluating azithromycin as the standard treatment for genital chlamydia in women.

PMID:
25925662
PMCID:
PMC4419407
DOI:
10.1186/s12879-015-0939-3
[Indexed for MEDLINE]
Free PMC Article

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