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

BMC Infectious Diseases

Research Article

Fabian YS Kong¹  Jane S Hocking¹  Andrew P Craig²  David P Wilson²  Basil Donovan³  Roger G Rank⁴  Laxmi Yeruva⁴ 

[1]Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3004, Melbourne, Victoria, Australia

[2]The Kirby Institute, UNSW Australia, 2052, Sydney, NSW, Australia

[3]The Kirby Institute, UNSW Australia, 2052, Sydney, NSW, Australia

[4]Sydney Sexual Health Centre, Sydney Hospital, 2000, Sydney, NSW, Australia

[5]University of Arkansas for Medical Sciences & Arkansas Children’s Hospital Research Institute, 72202, Little Rock, AR, USA

关键词: Chlamydia;    Azithromycin;    Doxycycline;    Re-infection;   

DOI  :  10.1186/s12879-015-0939-3

 received in 2015-01-14, accepted in 2015-04-23,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundSingle-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.MethodsWe 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.ResultsWhen the possibility of autoinoculation is taken into account, we calculate that doxycycline effectiveness may be 97% compared to just 82% for azithromycin.ConclusionsConsideration should be given to re-evaluating azithromycin as the standard treatment for genital chlamydia in women.

【 授权许可】

Unknown   
© Craig et al.; licensee BioMed Central. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.