阿奇霉素和多西环素治疗直肠衣原体感染的疗效：南澳大利亚的一项回顾性队列研究。

The efficacy of azithromycin and doxycycline treatment for rectal chlamydial infection: a retrospective cohort study in South Australia.

作者信息

Li Bin, Hocking Jane S, Bi Peng, Bell Charlotte, Fairley Christopher K

机构信息

School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.

STI Services (Clinic 275), Infectious Disease Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

出版信息

Intern Med J. 2018 Mar;48(3):259-264. doi: 10.1111/imj.13624.

DOI:10.1111/imj.13624

PMID:28967178

Abstract

BACKGROUND

There are ongoing concerns about treatment failure with azithromycin for the treatment of rectal chlamydia.

AIM

To investigate treatment efficacy of two treatments for rectal chlamydial infection.

METHODS

We performed a retrospective analysis of all patients diagnosed with rectal chlamydial infection between 2009 and 2015 in Adelaide, Australia. Patients were treated with either azithromycin (1 g single dose) or doxycycline (100 mg twice a day for 10 days) and returned for repeat testing 14-180 days after treatment commenced. Log-binomial models were used to estimate the relative risk (RR) of recurrent rectal chlamydia associated with the treatment with azithromycin versus doxycycline.

RESULTS

In men, rectal chlamydia prevalence was 6.7%, and in women, it was 8.1%. Of the 526 patients diagnosed with rectal chlamydial infections, 419 (79.7%), 93 (17.7%) and 14 (2.6%) patients were treated with doxycycline, azithromycin or other medication respectively. Of these patients, 173 (41.3%) of 419 doxycycline-treated patients and 31 (33.3%) of 93 azithromycin-treated patients were retested between 14 and 180 days after treatment commenced (P = 0.16). Among these patients, the repeat rectal chlamydia test was less commonly positive in those treated with doxycycline (5.8%; 95% confidence interval (CI) 0.03-0.10) compared with those treated with azithromycin (19.4%; 95% CI 0.09-0.36) and (P = 0.01). In the multivariate analysis, azithromycin-treated patients had a significantly higher risk of a positive test in the 14 and 180 days after treatment commenced (adjusted relative risk (aRR) 2.96, 95% CI 1.16-7.57).

CONCLUSION

The findings suggest that doxycycline may be more effective than azithromycin in treating rectal chlamydial infections.

摘要

背景

阿奇霉素治疗直肠衣原体感染的治疗失败问题一直备受关注。

目的

研究两种治疗直肠衣原体感染方法的疗效。

方法

我们对2009年至2015年期间在澳大利亚阿德莱德诊断为直肠衣原体感染的所有患者进行了回顾性分析。患者接受阿奇霉素（单次剂量1克）或多西环素（每日两次，每次100毫克，共10天）治疗，并在治疗开始后14 - 180天返回进行复查。采用对数二项式模型估计与阿奇霉素治疗相比，多西环素治疗复发性直肠衣原体感染的相对风险（RR）。

结果

男性直肠衣原体患病率为6.7%，女性为8.1%。在526例诊断为直肠衣原体感染的患者中，分别有419例（79.7%）、93例（17.7%）和14例（2.6%）患者接受了多西环素、阿奇霉素或其他药物治疗。在这些患者中，419例接受多西环素治疗的患者中有173例（41.3%），93例接受阿奇霉素治疗的患者中有31例（33.3%）在治疗开始后14至180天进行了复查（P = 0.16）。在这些患者中，接受多西环素治疗的患者复查时直肠衣原体检测呈阳性的情况比接受阿奇霉素治疗的患者少见（5.8%；95%置信区间（CI）0.03 - 0.10），而接受阿奇霉素治疗的患者为19.4%；95% CI 0.09 - 0.36），（P = 0.01）。在多变量分析中，接受阿奇霉素治疗的患者在治疗开始后14至180天检测呈阳性的风险显著更高（调整后相对风险（aRR）2.96，95% CI 1.16 - 7.57）。