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==Medical Therapy==
==Medical Therapy==
[[Image:ChlamydiaTrachomatisEinschlusskörperchen.jpg|thumb|right|''Chlamydia trachomatis'' inclusion bodies (brown) in a McCoy cell culture.]]  
[[Image:ChlamydiaTrachomatisEinschlusskörperchen.jpg|thumb|right|''Chlamydia trachomatis'' inclusion bodies (brown) in a McCoy cell culture.]]  
''C. trachomatis'' infection can be effectively cured with [[antibiotic]]s once it is detected. Current [[Centers for Disease Control]] guidelines provide for the following treatments:
 
* [[Azithromycin]] 1 gram oral as a single dose, or
{{PBI| Chlamydia trachomatis}}
* [[Doxycycline]] 100 milligrams twice daily for seven days.
:* 1 '''Chlaymydial infections '''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
* [[Tetracycline]]
::* 1.1 '''Chlamydial Infections in Adolescents and Adults'''
* [[Erythromycin]]
:::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 7 days
Untested Treatments
:::* Preferred regimen (2): [[Azithromycin]] 1 g PO in a single dose
* [[Ciprofloxacin]] 500 milligrams twice daily for 3 days.  (Although this is not an approved method of treatment, as it is shown to be ineffective and may simply delay symptoms.)
:::* Alternative regimen (1): [[ Erythromycin]] base 500 mg PO qid for 7 days
[[β-lactams]] are not suitable drugs for the treatment of chlamydia. While they have the ability to halt growth of the organism (i.e. are microbistatic), these antibiotics do not eliminate the bacteria. Once treatment is stopped, the bacteria will begin to grow once more. (See below for Persistence.)
:::* Alternative regimen (2): [[Erythromycin]] ethylsuccinate 800 mg PO qid for 7 days
:::* Alternative regimen (3): [[Levofloxacin]] 500 mg PO qd for 7 days
:::* Alternative regimen (4): [[Ofloxacin]] 300 mg PO bid for 7 days.
:::* Note: Patients should be instructed to refer their sex partners for evaluation, testing, and treatment if they had sexual contact with the patient during the 60 days preceding onset of the patient's symptoms or chlamydia diagnosis.
::* 1.2 '''Chlamydial Infections in patients with HIV Infection'''
:::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 7 days
:::* Preferred regimen (2): [[Azithromycin]] 1 g PO in a single dose
:::* Preferred regimen (3): [[Azithromycin]] 1 g PO in a single dose
:::* Alternative regimen (1): [[ Erythromycin]] base 500 mg PO qid for 7 days
:::* Alternative regimen (2): [[Erythromycin]] ethylsuccinate 800 mg PO  qid for 7 days
:::* Alternative regimen (3): [[Levofloxacin]] 500 mg  PO qd for 7 days
:::* Alternative regimen (4): [[Ofloxacin]] 300 mg PO bid for 7 days.
::* 1.3 '''Pregancy'''
:::* Preferred regimen: [[Azithromycin]] 1 g PO in a single dose
:::* Alternative regimen (1): [[ Amoxicillin]]  500 mg PO tid for 7 days
:::* Alternative regimen (2): [[ Erythromycin]] base 500 mg PO qid for 7 days
:::* Alternative regimen (3): [[Erythromycin]] base 250 mg PO  qid for 14 days
:::* Alternative regimen (4): [[ Erythromycin]] ethylsuccinate 800 mg PO qid for 7 days
:::* Alternative regimen (5): [[Erythromycin]] ethylsuccinate 400 mg PO qid for 14 days
:::* Note:[[ Doxycycline]], [[Ofloxacin]], and [[Levofloxacin]] are contraindicated in pregnant women
::* 1.4 '''Management of sex partners'''
:::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 7 days  
:::* Preferred regimen (2): [[Azithromycin]] 1 g PO in a single dose
:::* Alternative regimen (1): [[ Erythromycin]] base 500 mg PO qid for 7 days
:::* Alternative regimen (2): [[Erythromycin]] ethylsuccinate 800 mg PO qid for 7 days
:::* Alternative regimen (3): [[Levofloxacin]] 500 mg  PO qd for 7 days
:::* Alternative regimen (4): [[Ofloxacin]] 300 mg PO bid for 7 days.  
:::* Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or Chlamydia diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
:::* Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
:::* Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present
:* 2. '''Chlamydial infection among neonates'''
::* 2.1 '''Ophthalmia Neonatorum'''caused by ''C. trachomatis''
:::* Preferred regimen: [[ Erythromycin]]  base or ethylsuccinate 50 mg/kg/ day  PO qid for 14 days
:::* Alternative regimen: [[Azithromycin ]]suspension 20 mg/kg /day PO qd for 3 days
:::* Note: The mothers of infants who have chlamydial infection and the sex partners of these women should be evaluated and treated.
::* 2.2 '''Infant Pneumonia'''
:::* Preferred regimen: [[ Erythromycin]]  base or ethylsuccinate 50 mg/kg/ day  PO qid for 14 days
:::* Alternative regimen: [[Azithromycin ]]suspension 20 mg/kg /day PO qd for 3 days
:* 3.'''Chlamydial infection among infants and childern'''
::* 3.1 '''Infants and childern who weigh < 45 kg'''
:::* Preferred regimen: [[Erythromycin]]  base or ethylsuccinate 50 mg/kg/ day PO qid for 14 days
::* 3.2 '''Infants and childern who weigh ≥45 kg but who are aged <8 years'''
:::* Preferred regimen: [[Azithromycin]] 1 g PO in a single dose
::* 3.3 '''Infants and childern aged  ≥8 years'''
:::* Preferred regimen (1): [[Azithromycin]] 1 g PO in a single dose
:::* Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 7 days
:* 4. '''Lymphogranuloma venereum (LGV) '''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
::* Preferred regimen: [[Doxycycline]] 100 mg PO bid for 21 days
::* Alternative regimen: [[ Erythromycin]] base 500 mg PO qid for 21 days
::* Note (1): [[Azithromycin]] 1 g PO once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.
::* Note (2): Pregnant and lactating women should be treated with [[Erythromycin]]. [[Azithromycin]] might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. [[Doxycycline]] is contraindicated in pregnant women.
::* Note (3): Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.
::* Note (4): Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined and tested for urethral, cervical, or rectal chlamydial infection depending on anatomic site of exposure. They should be presumptively treated with a chlamydia regimen ( [[Azithromycin]] 1 g PO single dose {{or}} [[Doxycycline]] 100 mg PO bid for 7 days).
 
----


==References==
==References==

Revision as of 21:20, 10 August 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Medical Therapy

Chlamydia trachomatis inclusion bodies (brown) in a McCoy cell culture.
  • 1 Chlaymydial infections [1]
  • 1.1 Chlamydial Infections in Adolescents and Adults
  • Preferred regimen (1): Doxycycline 100 mg PO bid for 7 days
  • Preferred regimen (2): Azithromycin 1 g PO in a single dose
  • Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
  • Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
  • Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
  • Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days.
  • Note: Patients should be instructed to refer their sex partners for evaluation, testing, and treatment if they had sexual contact with the patient during the 60 days preceding onset of the patient's symptoms or chlamydia diagnosis.
  • 1.2 Chlamydial Infections in patients with HIV Infection
  • Preferred regimen (1): Doxycycline 100 mg PO bid for 7 days
  • Preferred regimen (2): Azithromycin 1 g PO in a single dose
  • Preferred regimen (3): Azithromycin 1 g PO in a single dose
  • Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
  • Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
  • Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
  • Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days.
  • 1.3 Pregancy
  • 1.4 Management of sex partners
  • Preferred regimen (1): Doxycycline 100 mg PO bid for 7 days
  • Preferred regimen (2): Azithromycin 1 g PO in a single dose
  • Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
  • Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
  • Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
  • Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days.
  • Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or Chlamydia diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
  • Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
  • Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present
  • 2. Chlamydial infection among neonates
  • 2.1 Ophthalmia Neonatorumcaused by C. trachomatis
  • Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/ day PO qid for 14 days
  • Alternative regimen: Azithromycin suspension 20 mg/kg /day PO qd for 3 days
  • Note: The mothers of infants who have chlamydial infection and the sex partners of these women should be evaluated and treated.
  • 2.2 Infant Pneumonia
  • 3.Chlamydial infection among infants and childern
  • 3.1 Infants and childern who weigh < 45 kg
  • Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/ day PO qid for 14 days
  • 3.2 Infants and childern who weigh ≥45 kg but who are aged <8 years
  • 3.3 Infants and childern aged ≥8 years
  • Preferred regimen (1): Azithromycin 1 g PO in a single dose
  • Preferred regimen (2): Doxycycline 100 mg PO bid for 7 days
  • 4. Lymphogranuloma venereum (LGV) [2]
  • Preferred regimen: Doxycycline 100 mg PO bid for 21 days
  • Alternative regimen: Erythromycin base 500 mg PO qid for 21 days
  • Note (1): Azithromycin 1 g PO once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.
  • Note (2): Pregnant and lactating women should be treated with Erythromycin. Azithromycin might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. Doxycycline is contraindicated in pregnant women.
  • Note (3): Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.
  • Note (4): Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined and tested for urethral, cervical, or rectal chlamydial infection depending on anatomic site of exposure. They should be presumptively treated with a chlamydia regimen ( Azithromycin 1 g PO single dose OR Doxycycline 100 mg PO bid for 7 days).

References

  1. Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
  2. Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.

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