Abstract
INTRODUCTION: In 2021, the Centers for Disease Control and Prevention (CDC) changed treatment guidelines for chlamydia (Chlamydia trachomatis) infections in nonpregnant women, as substantial data demonstrated oral doxycycline at 100 mg twice daily for 7 days as superior to one-dose oral azithromycin at 1 g. Previously, the two antibiotic regimens were considered equivocal, allowing providers to opt for the shorter regimen course to optimize compliance and cure rate. METHODS: We assessed the compliance rate of patients in low-resource communities to the multidose doxycycline regimen via retrospective chart review. For a 12-month period, all nonpregnant adult female patients prescribed doxycycline for chlamydia infection at a county hospital system were included in the IRB-exempt study. Patients were called 7–10 days after initial doxycycline prescription to assess compliance, medication side effects, and adherence barriers. Noncompliant patients were offered a prescription for the azithromycin regimen. Patients were encouraged to repeat chlamydia testing in 4 weeks to assess for cure, or in 3 months for reinfection. RESULTS: Two hundred sixty-four patients met inclusion criteria, 193 (73.1%) of whom could be contacted. Patients were significantly compliant to multidose doxycycline despite barriers (P=.0002; 95% CI, 3.33–50.48), such as pharmacy-induced medication fill delay and medication side effects. Only 7 (58.3%) noncompliant patients desired to switch to azithromycin. Of the 105 compliant patients re-tested, most (87.6%) tested negative. CONCLUSION: The data demonstrated that patients in low-resource communities are significantly compliant with the CDC-recommended 7-day doxycycline regimen despite barriers to adherence. Therefore, even in low-resource communities, practitioners should prescribe multidose doxycycline for chlamydia infection in nonpregnant females.
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