Efficacy of single-dose azithromycin versus doxycycline in the treatment of cervical infections caused byChlamydia trachomatis

Ossewaarde, Jacobus M.; Plantema, F. H. F.; Rieffe, M.; Nawrocki, R P; Vries, Ankje de; Loon, Anton M. van

doi:10.1007/bf01989972

Cited by 42 publications

(19 citation statements)

References 13 publications

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“…Only our results with minocycline appear to confirm this, which may be due to the fact that establishment of infection in the oviducts takes longer following intravaginal inoculation. A single dose of azithromycin was highly effective in preventing chlamydial shedding and therefore in preserving fertility, and this observation is in keeping with clinical experience in chlamydial cervicitis (17).…”

Section: Discussionsupporting

confidence: 80%

Characteristics of murine model of genital infection with Chlamydia trachomatis and effects of therapy with tetracyclines, amoxicillin-clavulanic acid, or azithromycin

Beale

Upshon

1994

Antimicrob Agents Chemother

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(15). Experimental animal models have been of significant value in studying the pathogenesis of chlamydial infection, particularly the immunopathological sequelae of untreated asymptomatic infection in females-salpingitis, ectopic pregnancy, and tubal infertility. Nonhuman primate models resemble the human disease most closely (19), but these animals are costly and in restricted supply. Guinea pigs, rabbits, and cats have also been used (11,20,21 on fertility. The mouse pneumonitis biovar of C. trachomatis, MoPn, is genetically and antigenically distinct from human biovars (32) but has the advantage that it is a natural mouse pathogen, particularly of the respiratory tract. To our knowledge, the use of this strain in experimental genital tract chemotherapy has been restricted to two studies involving intrabursal inoculation of mice to induce hydrosalpinx and infertility (5, 26) and a third in which C. trachomatis MoPn was introduced intravaginally to progesterone-treated mice. In the last study, therapy experiments were terminated after 12 days and long-term sequelae were not described (3).We report here, for the first time, the development of an upper genital tract infection in progesterone-treated outbred mice caused by intravaginal inoculation with C. trachomatis MoPn, in which salpingitis, hydrosalpinx formation, and loss of fertility were observed. We have used the model to assess the effects of minocycline, doxycycline, amoxicillin-clavulanic acid, and azithromycin on chlamydial shedding and preservation of fertility. MATERUILS AND METHODS Organism

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Section: Discussionsupporting

confidence: 80%

Characteristics of murine model of genital infection with Chlamydia trachomatis and effects of therapy with tetracyclines, amoxicillin-clavulanic acid, or azithromycin

Beale

Upshon

1994

Antimicrob Agents Chemother

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“…Both regimens have been shown to result in satisfactory cure rates in clinical trials (20,21,32,34,40,43,49).…”

Section: Infections Caused By the Obligate Intracellular Bacteriummentioning

confidence: 99%

Effects of Azithromycin and Rifampin onChlamydia trachomatisInfection In Vitro

Dreses-Werringloer

Padubrin

Zeidler

et al. 2001

Antimicrob Agents Chemother

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Infections caused by the obligate intracellular bacteriumChlamydia trachomatis are among the most prevalent causes of ocular and urogenital diseases worldwide. Clinical manifestations of acute infections related to C. trachomatis serovars A to C or serovars D to K are trachoma or cervicitis and urethritis, respectively. These infections can progress to persistent infections, which may initiate a pathogenic process that leads to chronic diseases including blindness or pelvic inflammatory disease, ectopic pregnancy, tubal factor infertility, and chlamydia-induced arthritis, including Reiter's syndrome.Standard therapy for acute urogenital tract infections is a 7-day course of doxycycline or a single dose of azithomycin. Both regimens have been shown to result in satisfactory cure rates in clinical trials (20,21,32,34,40,43,49).Relapsing chlamydial infections are, however, a common problem, even though patients are often treated appropriately (6, 24, 56). Usually, recurrent infections are supposed to be a consequence of reinfection. Most of the clinical trials that have addressed relapsing chlamydial infections did not distinguish between reinfection and relapse and thus did not define the role of persistence. There are, however, recent reports of recurrent infections after appropriate antibiotic treatment which appeared to be a result of the persistence of chlamydia (15,25,38).This observation presents an apparent contradiction to results of determination of the MIC and the minimum bactericidal concentration (MBC), which clearly indicated successful suppression of chlamydial growth by clinically used antibiotics. The experimental setting involved with this kind of in vitro testing is, however, not truly reflective of the situation in vivo for chlamydial infection. In natural infections, chlamydia are usually exposed to antimicrobials long after an infection has been well established. In contrast, the conventional in vitro systems used for susceptibility testing represent a quite different condition, in that antibiotics are added usually 48 h after the infectious agent is added or are sometimes added simultaneously with the infectious agent. Recently, we could demonstrate that ciprofloxacin and ofloxacin not only failed to eradicate chlamydia from host cells but induced a persistent infection, although both antibiotics are efficient in susceptibility testing (16). Using this in vitro model, we investigated the efficacies of azithromycin, rifampin, and the combination of azithromycin and rifampin for the elimination of chlamydia from epithelial cells. MATERIALS AND METHODSCells. Cells of the HEp-2 cells line, a human laryngeal epidermoid cell line, were maintained at 37°C with 5% CO 2 in RPMI 1640 medium supplemented with 10% fetal calf serum (Seromed, Berlin, Germany), 1% L-glutamine, and 100 g of gentamicin (Seromed) per ml.Growth, purification, and titration of chlamydia. C. trachomatis serovar K/UW-31/Cx (obtained from the Washington Research Foundation, Seattle) was cultured in HEp-2 cells, as described recentl...

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“…TCs are the most effective of the antichlamydial agents (table 1) [4][5][6]. TCs inhibit protein synthesis of Chlamy dia by binding to the 30s subunit of ribosomes to block reorganization from RB to EB and multiplication of RBs.…”

Section: Tcsmentioning

confidence: 99%

“…In pregnant women, nursing mothers, or neonates, TCs are contraindicated and clarithromycin is recom mended. It has recently been reported that a single 1-g dose of oral azithromycin is as effective as standard regi mens of doxycycline, clarithromycin, or sparfloxacin in the treatment of genital chlamydial infections [6,10,11,17] , Effective single-dose therapy with azithromycin will reduce compliance problems.…”

Section: Treatments For Complicationsmentioning

confidence: 99%

Treatment of Chlamydial Conjunctivitis

Nakagawa¹

1997

Ophthalmologica

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Adult inclusion conjunctivitis and neonatal inclusion conjunctivitis are important infectious diseases commonly encountered by ophthalmologists in industrialized countries. Patients with inclusion conjunctivitis are frequently complicated by genitourinary and epipharyngeal chlamydial infections. Thus, treatment of chlamydial conjunctivitis must include systemic antibiotics and not be limited to topical application of antibiotics to the eye. Effective antichlamydial agents include tetracyclines, macrolides, and some of the fluoroquinolones. Prolonged and frequent application of ophthalmic agents is vital for successful treatment of conjunctivitis.

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Efficacy of single-dose azithromycin versus doxycycline in the treatment of cervical infections caused byChlamydia trachomatis

Cited by 42 publications

References 13 publications

Characteristics of murine model of genital infection with Chlamydia trachomatis and effects of therapy with tetracyclines, amoxicillin-clavulanic acid, or azithromycin

Characteristics of murine model of genital infection with Chlamydia trachomatis and effects of therapy with tetracyclines, amoxicillin-clavulanic acid, or azithromycin

Effects of Azithromycin and Rifampin onChlamydia trachomatisInfection In Vitro

Treatment of Chlamydial Conjunctivitis

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