Efficacy and Safety of Azithromycin versus Lymecyline in the Treatment of Genital Chlamydial Infections in Women

Non-gonococcal urethritis (NGU), or inflammation of the urethra, is the most common treatable sexually transmitted syndrome in men, with approximately 20-50 % of cases being due to infection with Chlamydia trachomatis and 10-30 % Mycoplasma genitalium. Other causes are Ureaplasma urealyticum, Trichomonas vaginalis, anaerobes, Herpes simplex virus (HSV) and adenovirus. Up to half of the cases are non-specific. Urethritis is characterized by discharge, dysuria and/or urethral discomfort but may be asymptomatic. The diagnosis of urethritis is confirmed by demonstrating an excess of polymorpho-nuclear leucocytes (PMNLs) in a stained smear. An excess of mononuclear leucocytes in the smear indicates a viral etiology. In patients presenting with symptoms of urethritis, the diagnosis should be confirmed by microscopy of a stained smear, ruling out gonorrhea. Nucleid acid amplifications tests (NAAT) for Neisseria gonorrhoeae, C. trachomatis and for M. genitalium. If viral or protozoan aetiology is suspected, NAAT for HSV, adenovirus and T. vaginalis, if available. If marked symptoms and urethritis is confirmed, syndromic treatment should be given at the first appointment without waiting for the laboratory results. Treatment options are doxycycline 100 mg x 2 for one week or azithromycin 1 gram single dose or 1,5 gram distributed in five days. However, azithromycin as first line treatment without test of cure for M. genitalium and subsequent Moxifloxacin treatment of macrolide resistant strains will select and increase the macrolide resistant strains in the population. If positive for M. genitalium, test of cure samples should be collected no earlier than three weeks after start of treatment. If positive in test of cure, moxifloxacin 400 mg 7–14 days is indicated. Current partner(s) should be tested and treated with the same regimen. They should abstain from intercourse until both have completed treatment. Persistent or recurrent NGU must be confirmed with microscopy. Reinfection and compliance must be considered. Evidence for the following recommendations is limited, and is based on clinical experience and guidelines. If doxycycline was given as first therapy, azithromycin five days plus metronidazole 4–500 mg twice daily for 5–7 days should be given. If azithromycin was prescribed as first therapy, doxycycline 100 mg x 2 for one week plus metronidazole, or moxifloxacin 400 mg orally once daily for 7–14 days should be given.

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“…Lymecycline or tetracycline hydrochlorine do not induce photosensitivity and can be prescribed if sun exposure cannot be avoided [ 54 ].…”

Section: Treatmentmentioning

confidence: 99%

Management of non-gonococcal urethritis

2015

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“…Hillis and colleagues conducted a clinical trial in women with cervicitis to determine the therapeutic effects of single 1-g dose of azithromycin and twice daily 100░mg doses of doxycycline over seven days in preventing persistent or recurring chlamydia over one month, and reported a treatment failure of 5.1% in the azithromycin group and 4.1% in the doxycycline group (34). Brihmer and colleagues compared women with chlamydial cervicitis in terms of the therapeutic effects of a single 1░g░r oral dose of azithromycin and twice daily 300░mg doses of lymecycline over seven days and reported a treatment failure rate of 4.34% and 0% for azithromycin and lymecycline, respectively (36). Lowrence and colleagues investigated the recovery rate with 1░g of azithromycin in six strains clinically isolated through culture and PCR and reported no genomic mutations in the ribosomal leukocytes that could develop a direct resistance to azithromycin (50).…”

Section: Discussionmentioning

confidence: 99%

Urogenital chlamydia trachomatis treatment failure with azithromycin: A meta-analysis

Mohammadzadeh

Dolatian

Jorjani

et al. 2019

IJRM

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Background: Chlamydia Trachomatis is one of the most common pathogens transmitted through the genital tract in humans that leads to urogenital infection. Objective: Given the high prevalence of chlamydia infection and its adverse effects on the health of women and men, the present meta-analysis was conducted to determine the rate of treatment failure with azithromycin. Materials and Methods: Databases including MEDLINE, ISI - Web of Science, PubMed, EMBASE, Scopus, ProQuest, and Science Direct were searched for articles published between 1991 and 2018. The quality of the selected articles was assessed using the Cochrane risk of bias assessment tool. Heterogeneity was determined using the I2 and Cochrane Q-Test. Subgroup analysis and meta-regression were used to compare the prevalence rates on different levels of the variables. Results: A total of 21 articles that met the inclusion criteria were ultimately assessed. The pooled estimate of azithromycin failure rate was 11.23% (CI 95%: 8.23%-14.24%). Also, the azithromycin failure rate was 15.87% (CI 95%: 10.20%-21.54%) for the treatment of urethritis, 7.41% (CI 95%: 0.60%-14.22%) for cervicitis, and 7.14% (CI 95%: 10.90%-3.39%) for genital chlamydia. The pooled estimate of failure rate difference was 2.37% (CI 95%: 0.68%-4.06%), which shows that azithromycin has a higher failure rate in the treatment of chlamydia compared to doxycycline and other examined medications. The meta-regression results showed that the patient’s age contributes significantly to the heterogeneity for azithromycin treatment failure rate (β = 0.826; p = 0.017). Conclusion: Azithromycin has a higher failure rate than doxycycline and other studied medications in treating urogenital chlamydia infections. Key words: Azithromycin, Chlamydia trachomatis, Urogenital, Treatment failure, Meta-analysis.

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“…If the laboratory results come negative, only symptomatic patients that have evidence of urethritis should be treated. Any visible purulent discharge in symptomatic patients should warrant treatment with the proper antibiotics as well [7].…”

Section: Treatmentmentioning

confidence: 99%

Aetiologies and Management of Urethritis in Men: A Systematic Review and Meta-Analysis

Alsenani¹,

ijar²,

Kalim³

et al. 2020

IJAR

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Chlamydia trachomatis and Neisseria gonorrhoea are amongst the most common causes for urethritis and epididymitis in men. Management consists of taking a complete sexual history, examinations of the genital area, assessment of laboratory proof of infection, antimicrobial treatment guided towards the significant aetiologies, and therapy of sexual partners. Therapy of N. gonorrhoea calls for making use of a single-dose program targeting this microorganism, plus a 7-to 10-day tetracycline regimen against C. trachomatis and non-gonococcal urethritis. Microbiologic failure is seldom seen in patients taking the proper treatment regimens. However, recurrent urethritis is commonly seen nevertheless. Patients with consistent or recurring symptoms require a cautious re-evaluation, and re-treatment if cultures of polymorphonuclear leukocytes were found in urethral secretions. Although some patients will stay symptomatic and have an increased number of polymorphonuclear leukocytes in urethral secretions, additional treatment is typically not indicated. One of the most vital causes of prostatitis and epididymitis in older males or males with structural anomalies of the urethra are classic urinary system microorganisms as opposed to sexually transferred pathogens. Treatment of these infections consists of getting laboratory evidence of infection and medications against specific pathogens. Men with signs of "prostatitis" need to be assessed making use of both urine and prostatic secretions to look for infection and inflammation. Most of the males with these signs do not have an infection that can be laboratory documented. These patients react poorly to the medication regimen. Males with recorded persistent microbial prostatitis need lengthy regimens of antimicrobials to have an effective treatment. In many cases, nevertheless, the illness is resistant, and persistent treatment with antimicrobials might be needed for the best outcome. Our aim in this article, we will review the causes of urethritis in men and the management plan to treat this common disease.

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Efficacy and Safety of Azithromycin versus Lymecyline in the Treatment of Genital Chlamydial Infections in Women

Cited by 11 publications

References 13 publications

Management of non-gonococcal urethritis

Management of non-gonococcal urethritis

Urogenital chlamydia trachomatis treatment failure with azithromycin: A meta-analysis

Aetiologies and Management of Urethritis in Men: A Systematic Review and Meta-Analysis

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