Chlamydial infections, treatment

Calcium-channel blockers for the treatment of hypertension Calcium products Cephalosporins Cerebroactive medications Chlamydial infections treatment of Cholinergic drugs uses in medicine Cholinergic-receptor-blocking agents uses of Cirrhosis treatment of Congestive heart failure treatment of Constipation drug-induced Corticosteroids uses for Crohn s disease treatment of Cytokines their actions... 

Type of Infection Uncomplicated infections of the cervix, urethra, and rectum in adultsc,d Recommended Regimens0 Ceftriaxone 125 mg IM once/ or cefixime 400 mg po once/5 or ciprofloxacin 500 mg po once/ or ofloxacin 400 mg po once/ or levofloxacin 250 mg po once plus A treatment regimen for presumptive C. trachomatis coinfection if chlamydial infection has not been ruled out (see Table 121 -8 in Pharmacotherapy A Pathophysiologic Approach, seventh edition)... 

A treatment regimen for presumptive C trachomatis coinfection if chlamydial infection has not been ruled out (see Table 121-8 in Pharmacotherapy A Pathophysiologic Approach, seventh edition)... 

Recommended regimens for treatment of chlamydial infections are given in Table 46-8. Single-dose azithromycin and 7-day doxycycline are the... 

Treatment of chlamydial infections with the recommended regimens is highly effective therefore, posttreatment cultures are not routinely recommended. 

Efficacy In other conditions The clinical efficacy in the treatment of stromal keratitis and uveitis caused by herpes simplex or ophthalmic infections caused by vaccinia virus and adenovirus, or in the prophylaxis of herpes simplex virus keratoconjunctivitis and epithelial keratitis has not been established by well-controlled clinical trials. Not effective against bacterial, fungal, or chlamydial infections of the cornea or trophic lesions. 

Although erythromycin is a well-established antibiotic, there are relatively few primary indications for its use. These indications include the treatment of Mycoplasma pneumoniae infections, eradication of Corynebacterium diphtheriae from pharyngeal carriers, the early preparox-ysmal stage of pertussis, chlamydial infections, and more recently, the treatment of Legionnaires disease, Campylobacter enteritis, and chlamydial conjunctivitis, and the prevention of secondary pneumonia in neonates. 

Chloramphenicol is used topically in the treatment of eye infections because of its broad spectrum and its penetration of ocular tissues and the aqueous humor. It is ineffective for chlamydial infections. 

Topical tetracycline may be nsed as an adjnnctive therapy for chlamydial infections but not for initial treatment of acute bacterial conjunctivitis. Numerous organisms are resistant to tetracycline. 

Topical antibiotic agents alone are inadequate and unnecessary when systemic treatment is administered. A single dose of ceftriaxone, 25 to 50 mg/kg intravenously or intramuscularly, not to exceed 125 mg, is the regimen currently recommended by the CDC. Simultaneous infection with C. trachomatis should be considered when a patient does not improve after treatment. Both mother and infent should be tested for chlamydial infection at the same time that gonorrhea testing is conducted. 

Most patients presenting with pyuria will, in facL have infection that requires treatment. Single-dose or short-course therapy with trimethoprim-sulfamethoxazole has been used effectively, and prolonged courses of therapy are not necessary for most patients. If single-dose or short-course therapy is ineffective, a culture should be obtained. If the patient reports recent sexual activity, therapy for C. trachomatis should be considered. Chlamydial treatment should consist of 1-g azithromycin or doxycycline 100 mg twice daily for 7 days. Often, concomitant treatment of all sexnal partners is re-qnired to cure chlamydial infections and prevent reacqnisition (see Chap. 115). 

Eor pregnant women with chlamydial urogenital infections, treatment can reduce the risk of pregnancy complications and transmission to the newborn significantly. Because the use of tetracyclines and fluoroquinolones is contraindicated during pregnancy, erythromycin base and amoxicillin are the recommended drug treatments (see Table 115-8). Some clinicians prefer amoxicillin to erythromycin because of better patient tolerability and, as a resulf improved patient compliance. Patients intolerant of... 

Treatment of chlamydial infections with the recommended regimens is highly effective therefore, posttreatment laboratory testing is not recommended routinely unless symptoms persist or there are other specific concerns (e.g., pregnancy). Posttreatment tests should not be performed for at least 3 weeks following completion of therapy. When posttreatment tests are positive, they usually represent noncompliance, failure to treat sexual partners, or laboratory error rather than inadequate therapy or resistance to therapy. Infants with pneumonitis should receive follow-up testing because erythromycin is only 80% effective, and a second course of therapy may be necessary. ° " ... 

Stenberg, K., and Mardh, P. A. (1993). Treatment of concomitant eye and genital chlamydial infection with erythromycin and roxithromycin. Acta Ophthalmol. (Copenh.)ll, 332-335. 

Martin, D. H., Mroczkowski, T. F., Dalu, Z. A., McCarty, J., Jones, R. B., Hopkins, S. J., and Johnson, R. B. (1992). A controlled trial of a single dose of azithromycin for the treatment of chlamydial urethritis and cervicitis. The Azithromycin for Chlamydial Infections Study Group. 

Bush, M. R., and Rosa, C. (1994). Azithromycin and erythromycin in the treatment of cervical chlamydial infection during pregnancy. Obstet. Gynecol 84, 61-63. 

Sulfonamides have activity against C trachomatis and can be used topically for the treatment of chlamydial infections of the eye... 

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