ABSTRACT

Introduction

Azithromycin was recommended as the first-line therapeutic regimen for treatment of genital infections in men and women by the Centers for Disease Control in 1998. A series of studies of azithromycin for treatment of rectal chlamydial infection in men who have sex with men (MSM) found that azithromycin was significantly less effective than doxycycline.

Areas covered

Literature on treatment of rectal C. trachomatis from 2000 through May 2020 was searched using PubMed. Retrospective and observational studies were identified documenting the frequency and treatment of rectal chlamydial infection in MSM, heterosexual men and women that reported lower efficacy of single-dose azithromycin compared to doxycycline. Literature on possible reasons for the lower efficacy were also reviewed including studies of antibiotic resistance, impact of organism load, and persistent infection in rectal specimens and pharmacokinetics and pharmacodynamics of azithromycin in rectal tissue.

Expert opinion

The available data suggests that single-dose azithromycin is not as effective as azithromycin for the treatment of rectal infection in MSM and women. Most of these data have been retrospective or from observational studies. Final recommendations will depend on the outcome of prospective, randomized, treatment studies. We may also need to examine other dosage regimens for azithromycin.

中文翻译：

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阿奇霉素治疗直肠生殖器沙眼衣原体感染：一个时代的终结？

摘要

介绍

阿奇霉素于1998年被美国疾病控制中心推荐为治疗男性和女性生殖器感染的一线治疗方案。 阿奇霉素治疗男男性行为者（MSM）直肠衣原体感染的系列研究发现阿奇霉素的效果明显不如强力霉素。

覆盖区域

使用 PubMed 搜索了 2000 年至 2020 年 5 月治疗直肠沙眼衣原体的文献。回顾性和观察性研究记录了 MSM、异性恋男性和女性中直肠衣原体感染的频率和治疗，报告单剂量阿奇霉素与多西环素相比疗效较低。还回顾了有关疗效较低的可能原因的文献，包括抗生素耐药性研究、微生物负荷的影响、直肠标本中的持续感染以及阿奇霉素在直肠组织中的药代动力学和药效学研究。

专家意见

现有数据表明，单剂量阿奇霉素在治疗 MSM 和女性直肠感染方面不如阿奇霉素有效。大多数这些数据是回顾性的或来自观察性研究。最终建议将取决于前瞻性、随机、治疗研究的结果。我们可能还需要检查阿奇霉素的其他给药方案。