Chlamydia | Questions & Answers | 2015 STD Treatment Guidelines

Question: Is azithromycin or doxycycline considered the first-line treatment for chlamydia? Are other preparations of azithromycin or doxycycline recommended for the treatment of chlamydia?

At the present time the CDC guidelines slightly favor treatment of chlamydia with a single 1 g dose of azithromycin over a seven-day course of doxycycline which can be administered as either 100 mg of doxycycline orally twice daily, or as a single daily dose of a formulation (brand name Doryx) which can be administered as 200 mg orally once daily, but is more expensive.   Both doxycycline regimens (the generic, twice daily regimen or the Doryx once daily regimen) should be administered for seven days.

The slight favoritism for azithromycin is present because of concerns that many patients may not complete all seven days of a course of doxycycline.  However, in the past year or so, there have been reports that azithromycin may be slightly less effective for chlamydial treatment than doxycycline, particularly when compliance of medication adherence can be assured.  Other recent reports have suggested that azithromycin may also be less effective for treatment of rectal chlamydial infections in particular.  This topic is one for which there is likely to be more information (and debate) in the not too distant future.