HCET Home
 

On this page

HCET Home > On-line Training > RVIPP Self Study Manual: Chlamydia > 5. Diagnosis & Treatment of Chlamydia

5. Diagnosis & Treatment of Chlamydia

Patients who should be treated for Chlamydia:

  1. Patients who have been screened and are found to be positive on any of the following commonly used tests for Chlamydia trachomatis:

    1. EIA*
    2. DNA probe*
    3. Chlamydia culture*
    4. Cervical/Urethral swab, urine PCR
    5. Cervical/Urethral swab, urine SDA (ProbeTec)
    6. Cervical/Urethral swab, urine TMA (GenProbe)
    7. DFA*

      8. * Sensitivity and/or specificity for this test are lower than for the other tests. If a patient is in a low risk epidemiologic group with a positive test, a physician should be consulted regarding management of this patient.

  2. Patients who present with any of the following:
    1. Contact with a sexual partner known to have chlamydia or gonorrhea
    2. Urethral discharge with> 10 wbc per HPF
    3. PID

  3. All sexual partners exposed within 60 days prior to patient date of treatment.

  4. Any person with gonorrhea, unless a simultaneous NAAT test for chlamydia was negative.

Treatment Recommendations

Non-pregnant Females/Males
Recommended Regimens Alternative Regimens
  • Azithromycin 1 gm po stat dose

    • OR
  • Doxycycline 100 mg po bid X 7 days
  • Ofloxacin 300 mg po bid X 7 days
    OR
  • Erythromycin base 500 mg po qid X 7 days
    OR
  • Erythromycin ethylsuccinate 800 mg po qid X 7 days
  • Levofloxacin 500 mg orally for 7 days

Pregnant Females
Recommended Regimens Alternative Regimens
  • Azithromycin 1 g orally in a single dose
    OR
  • Amoxicillin 500 mg po tid X 7 days
  • Erythromycin base 500 mg po qid X 7 days
    OR
  • Erythromycin base 250 mg po qid X 14 days
    OR
  • Erythromycin ethylsuccinate 800 mg po qid X 7 days
    OR
  • Erythromycin ethylsuccinate 400 mg po qid X 14 days

Contraindications

  • Erythromycin estolate is contraindicated in pregnant women
  • Doxycycline and other tetracycline-family antibiotics are contraindicated in pregnant women.
  • Ofloxacin and other quinolone family antibiotics are contraindicated in pregnant women.

Medication: Amoxicillin | Azithromycin | Doxycycline | Erythromycin | Ofloxacin

Amoxicillin

Dosage
Amoxicillin 500 mg orally 3 times a day for 7 days

Preparation
Capsules or tablets

Adverse Reactions
As with other penicillins, it may be expected that untoward reactions will be essentially limited to sensitivity phenomena. GI upset.

Contraindications
A history of allergic reaction to any of the penicillins is a contraindication.

Interactions
Chloramphenicol, erythromycins, sulfonamides, and tetracyclines may interfere with the bactericidal effects of penicillin. This has been documented in vitro; however, the clinical significance of this interaction is not well documented.

Age Restrictions
None

Azithromycin

Dosage
Azithromycin 1 gm orally in a single dose

Preparation
Powder or capsules

Adverse Reactions
Anaphylaxis, GI upset

Contraindications
Allergy to any macrolide or any Enthromycin family antibiotics

Interactions
H2 blockers and antacids may interfere with absorption, may increase theophylline levels and prolong PT in patients on Coumadin. This is unlikely to be a significant problem in patients taking single dose therapy.

Pregnancy & Lactation
Category B considered safe in pregnant women if indicated

Age Restrictions
None

Doxycycline

Dosage
Chlamydia and NGU - Doxycycline 100 mg orally 2 times a day for 7 days
PID/Epididymitis/Orchitis - Doxycycline 100 mg orally 2 times a day for 14 days

Preparation
Powder or capsules

Adverse Reactions
Photosensitivity, GI upset, rash, anaphylaxis

Precautions & Contraindications
Allergy to doxycycline or any tetracycline-family antibiotics

Interactions
Antacids interfere with absorption

Pregnancy & Lactation
Category D (Known teratogen) Do not use in pregnant or lactating females.

Age Restrictions
Not indicated in patients < 8 years of age (due to permanent scarring of teeth).

Erythromycin

Dosage
Chlamydia and NGU - Erythromycin 500 mg orally 4 times a day for 14 days
Preparation
Caplets

Adverse Reactions
GI (cramping, nausea, vomiting, and diarrhea), rash, anaphylaxis

Some clinicians recommend, if the 500 mg dose causes intolerable GI side-effects, that the patient may take 250 mg four times daily but double the remaining duration. (i.e., still take all prescribed pills). It is unclear whether this regimen is equally effective.

Precautions & Contraindications
History of allergy to erythromycin or other macrolide-family antibiotics, patients taking terfenadine (Seldane) or other long-acting antihistamines

Erythromycin estolate is contraindicated in pregnant women.

Interactions
Theophylline, Digoxin, ergotamine (increase levels of these drugs), Seldane and other long acting antihistamines (Leads to prolonged QT intervals and may cause sudden death)

Pregnancy & Lactation
Category B (no restrictions). Erythromycin estolate is contraindicated in pregnant women.

Age Restrictions
No restrictions

Ofloxacin

Dosage
Ofloxacin 300 mg orally twice a day for 7 days
Preparation
Tablets

Adverse Reactions
GI upset, hematologic abnormalities, rash, anaphylaxis

Precautions & Contraindications
Quinolone allergy
Ofloxacin and other quinolones are contraindicated in pregnant women.

Interactions
Antacids may interfere with absorption
Cimetidine may interfere with elimination
May increase cyclosporin levels
May increase levels of Theophylline
May increase levels of Coumadin
With nonsteroidal anti-inflammatory drugs, may increase the risk of CNS stimulation and convulsive seizures

Pregnancy & Lactation
Category C (Not recommended for use in pregnancy or in lactating women).

Age Restrictions
Should not be used in patients < 16 yrs. due to possible effects on developing bone and cartilage
 
Section: Main 1 2 3 4 5 6 7 8 9 10 11 12
HCET Home | Contact Us | Search & Sitemap | Privacy & Disclaimer

 
 

İHealth Care Education & Training, Inc.
URL: http://65.163.14.21/training/IPP/5DandT.htm
 Last update: 03/05/08