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The efficacy of azithromycin and doxycycline for the treatment of rectal chlamydia infection: a systematic review and meta-analysis.

AbstractBACKGROUND:
There are increasing concerns about treatment failure following treatment for rectal chlamydia with 1 g of azithromycin. A systematic review and meta-analysis was conducted to investigate the efficacy of 1 g of azithromycin as a single dose or 100 mg of doxycycline twice daily for 7 days for the treatment of rectal chlamydia.
METHODS:
Medline, Embase, PubMed, Cochrane Controlled Trials Register, Australia New Zealand Clinical Trial Register and ClinicalTrials.gov were searched to the end of April 2014. Studies using 1 g of azithromycin or 7 days of doxycycline for the treatment of rectal chlamydia were eligible. Gender, diagnostic test, serovar, symptomatic status, other sexually transmitted infections, follow-up time, attrition and microbial cure were extracted. Meta-analysis was used to calculate pooled (i) azithromycin and doxycycline efficacy and (ii) efficacy difference.
RESULTS:
All eight included studies were observational. The random-effects pooled efficacy for azithromycin (based on eight studies) was 82.9% (95% CI 76.0%-89.8%; I(2) = 71.0%; P < 0.01) and for doxycycline (based on five studies) was 99.6% (95% CI 98.6%-100%; I(2) = 0%; P = 0.571), resulting in a random-effects pooled efficacy difference (based on five studies) of 19.9% (95% CI 11.4%-28.3%; I(2) = 48.5%; P = 0.101) in favour of doxycycline.
CONCLUSIONS:
The efficacy of single-dose azithromycin may be considerably lower than 1 week of doxycycline for treating rectal chlamydia. However, the available evidence is very poor. Robust randomized controlled trials are urgently required.
AuthorsFabian Yuh Shiong Kong, Sepehr N Tabrizi, Christopher Kincaid Fairley, Lenka A Vodstrcil, Wilhelmina M Huston, Marcus Chen, Catriona Bradshaw, Jane S Hocking
JournalThe Journal of antimicrobial chemotherapy (J Antimicrob Chemother) Vol. 70 Issue 5 Pg. 1290-7 (May 2015) ISSN: 1460-2091 [Electronic] England
PMID25637520 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
Copyright© The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: [email protected].
Chemical References
  • Anti-Bacterial Agents
  • Azithromycin
  • Doxycycline
Topics
  • Anti-Bacterial Agents (administration & dosage)
  • Azithromycin (administration & dosage)
  • Chlamydia (drug effects)
  • Chlamydia Infections (drug therapy)
  • Doxycycline (administration & dosage)
  • Humans
  • Observational Studies as Topic
  • Rectal Diseases (drug therapy)
  • Treatment Outcome

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