eMedicine Specialties > Ophthalmology > Infectious Disease
Chlamydia: Treatment & Medication
Updated: Nov 2, 2007
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
- Simultaneous treatment of all sexual partners is important to prevent reinfection. It also is prudent to examine all sexual partners for other venereal diseases, such as gonorrhea, syphilis, and HIV.
- Treatment consists of systemic antibiotics; topical antibiotics are relatively ineffective in the treatment of this eye disease.
- Recommended treatment, which is given for 3-6 weeks, includes oral tetracycline (500 mg qid), oral doxycycline (100 mg bid), or oral erythromycin stearate (500 mg qid).
- Azithromycin can be given as a single dose of 1 g, which can be increased to 2 g if Neisseria gonorrhoeae is suspected.
- Tetracyclines are avoided in children younger than 7 years and in women who are pregnant or breastfeeding.
Consultations
Infectious disease specialist or sexually transmitted disease clinic as necessary
Activity
No sexual activity until the course of treatment is complete.
Medication
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Antibiotics
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Tetracycline (Sumycin)
Mainly bacteriostatic; inhibits bacterial protein synthesis by binding to 30S and to some extent 50S ribosomal subunits. They also may alter cytoplasmic membrane leading to leakage of intracellular components such as nucleotides from the cell.
Adult
250-500 mg PO qid for 3-6 wk
Pediatric
<8 years: Not established
>8 years: 25 mg/kg/d PO divided bid/qid to a maximum 50 mg/kg/d for severe infections
May potentiate effects of oral anticoagulants (monitor PT and adjust dose accordingly); bioavailability of digoxin may increase in a small subset of patients (<10%); bioavailability of tetracycline decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate (give 1-2 h before or after anti-infective); concurrent use of methoxyflurane anesthesia and tetracyclines may seriously impair renal function, leading in some cases to death; tetracycline can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy; bacteriostatic effects of tetracycline may interfere with bactericidal action of penicillin; antidiarrhea agents containing kaolin and pectin or bismuth subsalicylate may impair absorption of oral tetracyclines
Documented hypersensitivity; severe renal or hepatic dysfunction; pregnancy or lactation unless potential benefits to patient outweigh risk to the fetus or child; common infections in children <8-13 years
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Excessive systemic accumulation of the drug and liver toxicity may occur in renal impairment; when administered IV, tetracycline derivatives may cause burning at the injection site or phlebitis (administer slowly); avoid extravasation; photosensitivity may occur following exposure to sunlight; discontinue therapy at first sign of skin discomfort; superinfection may occur in prolonged therapy; acute Fanconi syndrome (nausea, vomiting, polyuria, polydipsia, albuminuria, glycosuria, aminoaciduria, hypophosphatemia, hypokalemia, and acidosis) may occur with outdated tetracyclines; in rare instances, oral tetracyclines have caused esophagitis and esophageal ulceration; in long-term therapy, periodic laboratory evaluation of organ systems, including hematopoietic, renal, and hepatic, recommended
Erythromycin (EES, Erythrocin, E-Mycin)
Macrolide antibiotic; inhibits protein synthesis by binding reversibly to 50S ribosomal subunits of susceptible microorganisms. Effect may be either bacteriostatic or bactericidal depending on sensitivity of the microorganism and concentration of the drug.
Adult
250-500 mg tab PO qid for 3-6 wk
Ointment: Apply tid for 2-3 wk
Pediatric
50 mg/kg PO divided qid for 3-6 wk
Ointment: Apply tid for 2-3 wk
Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis
Documented hypersensitivity; estolate formulation of erythromycin is contraindicated in liver disease or dysfunction
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI adverse effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur
Clarithromycin (Biaxin)
Exerts antibacterial action by binding to 50S ribosomal subunit of susceptible bacteria and suppressing protein synthesis.
Adult
250-500 mg PO qid for 3-6 wk
Pediatric
15 mg/kg/d PO divided q12h; not to exceed 1000 mg/d
Toxicity increases with coadministration of fluconazole and pimozide; clarithromycin effects decrease and GI adverse effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, carbamazepine, ergot alkaloids, triazolam, HMG CoA-reductase inhibitors; plasma levels of certain benzodiazepines may increase, prolonging CNS depression; arrhythmias and increase in QTc intervals occur with disopyramide; coadministration with omeprazole may increase plasma levels of both agents
Documented hypersensitivity; coadministration of pimozide
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Coadministration with ranitidine or bismuth citrate is not recommended with CrCl <25 mL/min; give half dose or increase dosing interval if CrCl <30 mL/min; diarrhea may be sign of pseudomembranous colitis; superinfections may occur with prolonged or repeated antibiotic therapies
Azithromycin (Zithromax)
Azalide subclass of macrolide antibiotics, derived from erythromycin. Acts by binding to 50S ribosomal subunit of susceptible microorganisms and, thus, interferes with microbial protein synthesis. Nucleic acid synthesis is not affected.
Adult
500 mg (2 250-mg cap) PO on d 1, followed by 250 mg (1 250-mg cap) qd on d 2-5; treatment for chlamydia is administered as a single 1 g dose in practice
Pediatric
10 mg/kg/d PO on d 1, followed by 5 mg/kg on d 2-5
May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine
Documented hypersensitivity; hepatic impairment; do not administer with pimozide
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine
Doxycycline (Doryx, Bio-Tab, Vibramycin)
Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. Usual doses of doxycycline may be used in patients with impaired renal function.
Adult
100 mg PO bid for 3-6 wk
Pediatric
>8 years:
<45 kg: 4.4 mg/kg/d PO qd or divided bid given on first d, followed by maintenance dose of 2.2-4.4 mg/kg/d PO qd or divided bid
>45 kg: Administer as in adults
Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy
Documented hypersensitivity; severe hepatic dysfunction; myasthenia gravis
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines
More on Chlamydia |
| Overview: Chlamydia |
| Differential Diagnoses & Workup: Chlamydia |
 Treatment & Medication: Chlamydia |
| Follow-up: Chlamydia |
| References |
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References
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Further Reading
Keywords
chlamydiae, Chlamydia trachomatis, Chlamydia psittaci, Chlamydia pneumoniae, C trachomatis, C psittaci, C pneumoniae, adult inclusion conjunctivitis, trachoma, paratrachoma, chronic follicular conjunctivitis, sexually transmitted disease, STD, genital chlamydial disease, gonorrhea
