With the exception of
lymphogranuloma venereum, the treatment of Chlamydia trachomatis
infections in the genital tract or acquired from the genital tract is relatively easy. In general, in vivo activity of antimicrobials against C. trachomatis correlates well with in vitro activity if sufficient antimicrobial is given for a long enough duration.
Tetracycline and
erythromycin and their derivatives remain the treatments of choice because of combined activity against C. trachomatis, in addition to most isolates of Neisseria gonorrhoeae and Ureaplasma urealyticum.
Rifampin,
sulfonamides, or
trimethoprim-sulfamethoxazole can only be used if C. trachomatis alone is being treated. Although multiple dose
penicillins may be significant activity in vivo, their use is not encouraged. Other antimicrobials like aminocyclitols,
cephalosporins, and
metronidazole have no activity. Seven day regimens of either a
tetracycline or
erythromycin are generally preferred for uncomplicated
infections, but ten days of a
tetracycline is preferred for complications like acute
pelvic inflammatory disease or
epididymitis. For ocular or pulmonary
infection in infants, a two to three week regimen of oral
sulfonamide or
erythromycin is preferred. for the treatment of concurrent N. gonorrhoeae and C. trachomatis, a
tetracycline should be administered for at least five days.