Adherence to doxycycline for uncomplicated genitourinary chlamydia: A prospective observational study

Area of Science:

• Infectious Diseases
• Public Health
• Clinical Pharmacy

Background:

• The US CDC updated guidelines in 2020, recommending a 7-day doxycycline course over single-dose azithromycin for uncomplicated genitourinary chlamydia.
• Adherence to antibiotic regimens is critical for treatment efficacy and preventing antimicrobial resistance.

Purpose of the Study:

• To investigate patient adherence to the 7-day doxycycline regimen for uncomplicated genitourinary chlamydia.
• To identify reasons for nonadherence.
• To compare on-site dispensing versus prescription for the doxycycline regimen.

Main Methods:

• Prospective observational study involving adult patients diagnosed with uncomplicated genitourinary chlamydia.
• Data collected from urban emergency departments (EDs) and a sexually transmitted infection (STI) clinic.
• Patient interviews conducted 2-4 weeks post-visit to assess adherence and reasons for nonadherence.

Main Results:

• Therapeutic adherence was 85% in the STI clinic and 77% in EDs.
• Nonadherence in EDs was associated with younger age and female sex (67% adherence).
• Reasons for nonadherence included side effects, cost, transportation, skepticism, and misunderstood instructions.

Conclusions:

• A significant number of patients do not adhere to the 7-day doxycycline regimen for chlamydia in EDs and STI clinics.
• The CDC's consideration of azithromycin for nonadherence concerns should be broadly applied.
• Barriers to adherence should be routinely discussed when selecting chlamydia treatment.