By F. Bruder Stapleton, MD

For incarcerated youth with chlamydia infection, treatment failure was very low with both doxycycline and azithromycin in a randomized trial published in the New England Journal of Medicine.

Investigators compared the efficacy of azithromycin (1 g in a single dose) versus doxycycline (100mg twice daily for 7 days) in treating Chlamydia trachomatis in over 300 youth aged 12–21 years in a correctional facility. Urogenital symptoms were reported in 25% of males and 61% of females.

No treatment failures occurred in the doxycycline group, compared with five in the azithromycin group (3.2%). Adverse events were similar in the two treatment groups and primarily included gastrointestinal problems.

This study failed to find noninferiority of azithromycin in a captive population in which no treatment failures occurred in the doxycycline arm.


Despite the impressive rigor of the study, its conditions do not closely mirror usual primary care. Furthermore, both treatments had a high success rate. For these reasons, in concurrence with an accompanying editorial, I believe that azithromycin continues to be an acceptable therapy for C. trachomatis


Full NEJM Journal Watch Pediatrics and Adolescent Medicine summary (Free) NEJM article (Free abstract)

NEJM editorial (Subscription required)