eMedicine Specialties > Emergency Medicine > Infectious Diseases

Chlamydia: Treatment & Medication

Author: Debra E Houry, MD, MPH, Director, Center for Injury Control, Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Emory University
Contributor Information and Disclosures

Updated: Apr 20, 2009

Treatment

Emergency Department Care

  • Begin antibiotic therapy as soon as possible. Consider compliance, cost, and potential adverse effects.
  • Consider treatment for possible gonorrhea co-infection (see Gonorrhea).
  • Send specimens from sites of infection to the lab for culture.
  • Perform a pregnancy test; this can alter antibiotic treatment and patient follow-up care.
  • Provide information and counseling to prevent future STDs and consider referral for HIV testing.
  • Encourage the patient to abstain from sexual intercourse until after treatment and testing of all partners is completed.

Consultations

  • Consult obstetrics/gynecology for any patient with severe PID and any pregnant patient with chlamydial infection.
  • Consult ophthalmology for patients with chlamydial conjunctivitis.

Medication

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

Antibiotics

The Centers for Disease Control and Prevention (CDC) recommends azithromycin and doxycycline as first-line drugs for the treatment of chlamydial infection.4 Medical treatment with these agents is 95% effective. Second-line drugs (eg, erythromycin, sulfa) are less effective and have more adverse effects. See guidelines for further information.


Azithromycin (Zithromax)

Treats mild to moderately severe microbial infections; DOC because of single-dose treatment, effectiveness, and lower cost.

Adult

1 g PO once

Pediatric

10 mg/kg PO once; not to exceed 1 g/d PO once

May increase toxicity of theophylline, warfarin, and digoxin; aluminum and/or magnesium antacids reduce effects; cyclosporine may cause nephrotoxicity and neurotoxicity

Documented hypersensitivity; hepatic impairment; concurrent pimozide (may cause sudden death)

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Site reactions can occur with IV route; bacterial or fungal overgrowth may result with prolonged antibiotic use; may increase hepatic enzymes and worsen cholestatic jaundice; caution in patients with impaired hepatic function, prolonged QT intervals, or pneumonia; caution in hospitalized, geriatric, or debilitated patients


Doxycycline (Bio-Tab, Doryx, Vibramycin)

Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria; secondary DOC because of higher cost and decreased compliance.

Adult

100 mg PO bid for 7 d

Pediatric

<8 years: Not recommended
>8 years: Administer as in adults

Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can increase hypoprothrombinemic effects of anticoagulants; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy

Documented hypersensitivity; severe hepatic dysfunction

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; use during tooth development (last 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
Multimedia: Chlamydia
References
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References

  1. U.S. Preventive Services Task Force. Screening for chlamydial infection: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. Jul 17 2007;147(2):128-34. [Medline]. [Full Text].

  2. Screening for chlamydial infection: recommendation statement. National Guideline Clearinghouse. Available at http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=10408&nbr=5454. Accessed March 23, 2009.

  3. Centers for Disease Control and Prevention. Chlamydia screening among sexually active young female enrollees of health plans--United States, 2000-2007. MMWR Morb Mortal Wkly Rep. Apr 17 2009;58(14):362-5. [Medline]. [Full Text].

  4. (1) Diseases characterized by urethritis and cervicitis. Sexually transmitted diseases treatment guidelines 2006. (2) Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. National Guideline Clearinghouse. Available at http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=10769&nbr=5597. Accessed March 23, 2009.

  5. Yealy DM, Greene TJ, Hobbs GD. Underrecognition of cervical Neisseria gonorrhoeae and Chlamydia trachomatis infections in the emergency department. Acad Emerg Med. Oct 1997;4(10):962-7. [Medline].

  6. Anttila T, Saikku P, Koskela P, et al. Serotypes of Chlamydia trachomatis and risk for development of cervical squamous cell carcinoma. JAMA. Jan 3 2001;285(1):47-51. [Medline].

  7. CDC. Sexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention. MMWR Recomm Rep. May 10 2002;51(RR-6):1-78. [Medline].

  8. Darville T. Chlamydia trachomatis infections in neonates and young children. Semin Pediatr Infect Dis. Oct 2005;16(4):235-44. [Medline].

  9. Datta SD, Sternberg M, Johnson RE, Berman S, Papp JR, McQuillan G. Gonorrhea and chlamydia in the United States among persons 14 to 39 years of age, 1999 to 2002. Ann Intern Med. Jul 17 2007;147(2):89-96. [Medline].

  10. Jensen JS, Bjornelius E, Dohn B, Lidbrink P. Comparison of first void urine and urogenital swab specimens for detection of Mycoplasma genitalium and Chlamydia trachomatis by polymerase chain reaction in patients attending a sexually transmitted disease clinic. Sex Transm Dis. Aug 2004;31(8):499-507. [Medline].

  11. Kelly JJ, Dalsey WC, McComb J, Njuki F. Follow-up program for emergency department patients with gonorrhea or chlamydia. Acad Emerg Med. Dec 2000;7(12):1437-9. [Medline].

  12. Magid D, Douglas JM Jr, Schwartz JS. Doxycycline compared with azithromycin for treating women with genital Chlamydia trachomatis infections: an incremental cost-effectiveness analysis. Ann Intern Med. Feb 15 1996;124(4):389-99. [Medline].

  13. Miller WC, Ford CA, Morris M, et al. Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA. May 12 2004;291(18):2229-36. [Medline].

  14. Stewart DP. Historical, physical, and laboratory characteristics of female ED patients with positive chlamydia and gonorrhea cultures. Am J Emerg Med. May 1996;14(3):336-7. [Medline].

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Further Reading

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Keywords

STD, sexually transmitted diseases, STDs, Chlamydia trachomatis, C trachomatis, bacterial infection, pelvic inflammatory disease, PID, infertility, chlamydial infection, chlamydia, detection of chlamydia infection, trachoma, chronic conjunctivitis, genital tract infections, lymphogranuloma venereum, genital ulcer disease 

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Contributor Information and Disclosures

Author

Debra E Houry, MD, MPH, Director, Center for Injury Control, Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Emory University
Debra E Houry, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Richard Lavely, MD, JD, MS, MPH, Lecturer in Health Policy and Administration, Department of Public Health, Yale University School of Medicine
Richard Lavely, MD, JD, MS, MPH is a member of the following medical societies: American College of Emergency Physicians, American College of Legal Medicine, and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jonathan A Handler, MD, Director of Informatics, Assistant Professor, Department of Emergency Medicine, Northwestern Memorial Hospital
Jonathan A Handler, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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