MilliporeSigma
  • Home
  • Search Results
  • Suboptimal adherence to doxycycline and treatment outcomes among men with non-gonococcal urethritis: a prospective cohort study.

Suboptimal adherence to doxycycline and treatment outcomes among men with non-gonococcal urethritis: a prospective cohort study.

Sexually transmitted infections (2013-10-10)
Christine M Khosropour, Lisa E Manhart, Danny V Colombara, Catherine W Gillespie, M Sylvan Lowens, Patricia A Totten, Matthew R Golden, Jane Simoni
ABSTRACT

Doxycycline, one of two recommended therapies for non-gonococcal urethritis (NGU), consists of a 7-day course of therapy (100 mg BID). Since suboptimal adherence may contribute to poor treatment outcomes, we examined the association between self-reported imperfect adherence to doxycycline and clinical and microbiologic failure among men with NGU. Men aged ≥16 years with NGU attending a Seattle, WA, sexually transmitted diseases clinic were enrolled in a double-blind, parallel-group superiority trial from January 2007 to July 2011. Men were randomised to active doxycycline/placebo azithromycin or placebo doxycycline/active azithromycin. Imperfect adherence was defined as missing ≥1 dose in 7 days. Urine was tested for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), and Ureaplasma urealyticum-biovar 2 (UU-2) using nucleic acid amplification tests. Clinical failure (symptoms and ≥5 PMNs/HPF or discharge) and microbiologic failure (positive tests for CT, MG, and/or UU-2) were determined after 3 weeks. 184 men with NGU were randomised to active doxycycline and provided data on adherence. Baseline prevalence of CT, MG and UU-2 was 26%, 13% and 27%, respectively. 28% of men reported imperfect adherence, and this was associated with microbiologic failure among men with CT (aRR=9.33; 95% CI 1.00 to 89.2) and UU-2 (aRR=3.08; 95% CI 1.31 to 7.26) but not MG. Imperfect adherence was not significantly associated with clinical failure overall or for any specific pathogens, but it was more common among imperfectly adherent men with CT (aRR=2.63; 0.93-7.41, p=0.07). Adherence may be important for microbiologic cure of select pathogens. Factors other than adherence should be considered for CT-negative men with persistent NGU.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Azithromycin dihydrate, ≥98% (HPLC)
Sigma-Aldrich
Doxycycline monohydrate
Sigma-Aldrich
Azithromycin
Supelco
Doxycycline hyclate, VETRANAL®, analytical standard
Supelco
Azithromycin, Pharmaceutical Secondary Standard; Certified Reference Material
Sigma-Aldrich
Doxycycline hyclate
Azithromycin, European Pharmacopoeia (EP) Reference Standard
Azithromycin for system suitability, European Pharmacopoeia (EP) Reference Standard
Azithromycin for peak identification, European Pharmacopoeia (EP) Reference Standard
Supelco
Doxycycline hyclate, Pharmaceutical Secondary Standard; Certified Reference Material