Azithromycin or Doxycycline for Chlamydia trachomatis Infection?

December 23, 2015

Azithromycin or Doxycycline for Chlamydia trachomatis Infection?

  1. F. Bruder Stapleton, MD

Treatment failure was 0% with doxycycline and only 3% with azithromycin in incarcerated youth, though noninferiority of azithromycin was not achieved.

  1. F. Bruder Stapleton, MD

For several years, the recommended treatment for urogenital infections from Chlamydia trachomatis has been either doxycycline or azithromycin, although some studies have suggested inferiority of azithromycin.

In the current randomized, noninferiority trial, investigators compared the efficacy of azithromycin (1 g in a single dose) and doxycycline (100 mg twice daily for 7 days) in treating C. trachomatis in 310 youth (age range, 12–21 years; 65% male) in a correctional facility. Doses were administered under direct observation, and treatment success was determined by nucleic acid amplification tests, sexual history, and genotyping of C. trachomatis. Urogenital symptoms were reported in only 25% of males, in contrast with 61% of females, half of whom reported vaginal discharge.

No treatment failures occurred in the doxycycline group, compared with five treatment failures in the azithromycin group (3.2%, 95% confidence interval, 0.4–7.4). Four of the five treatment failures were in male participants. Treatment failure rates differed by 3.2 percentage points with a one-sided 90% confidence interval of 0 to 5.9. The upper limit of 5.9 percentage points exceeded the noninferiority cutoff of 5 percentage points. Adverse events were similar between the two treatment groups and were primarily gastrointestinal problems.


This study failed to find noninferiority of azithromycin in a captive population in which no treatment failures occurred in the doxycycline arm. Despite the impressive rigor of the study, its conditions do not closely mirror usual primary care. Furthermore, both treatments had a high success rate. For these reasons, in concurrence with an accompanying editorial, I believe that azithromycin continues to be an acceptable therapy for C. trachomatis.

Editor Disclosures at Time of Publication

  • Disclosures for F. Bruder Stapleton, MD at time of publication Editorial boards UpToDate


Reader Comments (2)

Jimmy Conner, M.S.,PA-C Other Healthcare Professional, Infectious Disease, STD Clinic

The weakness in this study is this is a captive patient population. A significant number of patients in routine clinical setting is patient compliance with taking doxy bid for seven days. Also in private practice or STD clinics reinfection by untreated partners is common and persistent symptoms are nor true tx failure.

Pedro Andr?s Villalba Apestegui Resident, Infectious Disease, HIGA "Gral. San Martin" Argentina

Is nice to know thia resulta, because a lot of patients come with uretritis and the follow up la dificult with doxycicline.
Now we go to prescribe with more tranquility

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