Active substances: Azithromycin
San Diego, CA. The azithromycin will be donated by Pfizer International. One set of subjects 1 or 2 villages depending upon population size, in order to generate meaningful numbers will receive an initial treatment of 1.
After initial azithromycin treatment, follow-up examinations and specimen collection will be done 2, 12, and 24 months post-treatment for trachoma and chlamydial infection.
There will be no follow-up examinations.
It should be noted that in our previous ACT study, more than 8,000 people received azithromycin with no complaints beyond minor gastro-intestinal upset.
Only one retrospective study was identified that examined treatment in pregnant women and reported that efficacy with single-dose azithromycin exceeded that of amoxicillin and erythromycin.
A single study examining the efficacy of a beta-lactam antibiotic was stopped early due to high treatment failures. Conclusions The paucity of existing data highlights the need for further adequately powered studies to evaluate rifalazil, delayed release doxycycline, levofloxacin and other agents for the treatment of uncomplicated CT infections.
PROSPERO registration number Keywords: systematic review, chlamydia trachomatis, treatment Strengths and limitations of this study This review assesses non-standard treatment for Chlamydia trachomatis urogenital infections, a significant cause of global morbidity.
A broad search strategy was used, including studies in English and French and not restricting the geographical location of the studies.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane quality assessment tools were used to conduct the review.
The small number of included studies together with the variation in study methodologies precluded meta-analysis. Another meta-analysis including eight observational studies comparing azithromycin with doxycycline for rectal chlamydia infections reported a pooled efficacy difference of 19.
In addition, due to rising antimicrobial resistance in gonorrhoea to both azithromycin and doxycycline, alternate agents for patients coinfected with both gonorrhoea and chlamydia are desirable.
Other antibiotics listed in the guidelines include quinolones ofloxacin, levofloxacin, sitafloxacin and amoxicillin, all requiring multiday courses of treatment thus raising concerns about adherence.
Only English and French language studies were included.
For more details, see table 1. Table 1 Systematic literature search strategy protocol Criteria for studies Language: English and French literature.
Intervention: any antibiotic used for treatment other than azithromycin and doxycycline. Comparison: preferred therapy azithromycin or doxycycline, other antibiotics, no therapy, placebo.
Unintended effects: adverse events during treatment, development of antimicrobial resistance.
Study design: inclusion: primary research studies, including: Interventional studies randomised controlled trials, controlled clinical trials, observational studies cohort, case—control, cross-sectional and modelling studies.
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