阿奇霉素与多西环素治疗直肠及尿道沙眼衣原体感染的疗效对比  

Comparison of the efficacy of azithromycin and doxycycline for Chlamydia trachomatis infection in the rectum and urinary tract

作　　者：张晓辉 廖玉英 林晓昕 王柳苑 陈惠茹 吴育娇 谢冬梅 柯吴坚 李秀雯 赵培祯 杨立刚 ZHANG Xiaohui;LIAO Yuying;LIN Xiaoxin;WANG Liuyuan;CHEN Huiru;WU Yujiao;XIE Dongmei;KE Wujian;LI Xiuwen;ZHAO Peizhen;YANG Ligang(Dermatology Hospital,Southern Medical University,Guangzhou 510091,China;School of Public Health,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学皮肤病医院,广东广州510091 [2]南方医科大学公共卫生学院,广东广州510515

出　　处：《皮肤性病诊疗学杂志》2025年第3期180-184,共5页Journal of Diagnosis and Therapy on Dermato-venereology

基　　金：广州市健康医疗协同创新重大专项(201704020219)。

摘　　要：目的比较阿奇霉素与多西环素治疗直肠及尿道沙眼衣原体感染的疗效。方法2019年11月—2023年4月招募男男性行为志愿者进行直肠和/或尿道的沙眼衣原体检测,确诊感染患者随机分为两组,分别给予阿奇霉素和多西环素口服治疗。阿奇霉素第一天1 g,第二天和第三天各0.5 g;多西环素100 mg每天2次,连续7 d。停药3周后进行沙眼衣原体核酸检测,比较微生物清除率。结果共招募1596例志愿者,其中沙眼衣原体直肠感染125例,尿道感染59例,排除治疗后未复检者及研究期间有高危行为者后,纳入分析152例。其中阿奇霉素治疗97例,包括直肠感染72例,尿道感染25例;多西环素治疗55例,包括直肠感染30例,尿道感染25例。停药3周后,阿奇霉素组沙眼衣原体核酸检测全部阴性,总微生物清除率为100%(97/97);多西环素组中,直肠感染者5例阳性,尿道感染者2例阳性,总微生物清除率为87.27%(48/55),阿奇霉素组总微生物清除率明显高于多西环素组,差异有统计学意义(=12.94,P<0.001)。7例多西环素治疗后复检阳性者给予阿奇霉素治疗后复查均转阴。结论阿奇霉素2 g疗法可作为单纯性直肠及尿道沙眼衣原体感染的一线治疗方案。Objective The purpose of this study was to compare the efficacy of azithromycin and doxycycline in the treatment of Chlamydia trachomatis infection in the rectum and urinary tract.Methods From November 2019 to April 2023,male volunteers who had sex with men(MSM)were recruited for Chlamydia trachomatis testing of the rectum and urinary tract.Patients diagnosed with Chlamydia trachomatis infection were treated orally with either azithromycin or doxycycline.Azithromycin was given orally at a dose of 1 g on the first day,and 0.5 g on the second and third days,or 100 mg of oral doxycycline was given twice daily,for 7 consecutive days.Nucleic acid testing for Chlamydia trachomatis was conducted to compare the microbial clearance rates three weeks after the therapy.Results A total of 1596 MSM were recruited,including 125 cases of Chlamydia trachomatis rectal infection and 59 cases of urethral infection.After excluding individuals who did not undergo follow-up examinations and those having high-risk behaviors during the study period,152 cases of Chlamydia trachomatis infection were included in this study.Azithromycin was given to 97 cases,including 72 cases of rectal infection and 25 cases of urethral infection.Doxycycline was given to 55 cases,including 30 cases of rectal infection and 25 cases of urethral infection.Three weeks after the therapy,all cases in the azithromycin group were negative for Chlamydia trachomatis,while in the doxycycline group,5 cases of rectal infection and 2 cases of urethral infection were positive for Chlamydia trachomatis,resulting in a microbial clearance rate of 87.27%(48/55).The total microbial clearance rate in the azithromycin group was significantly higher than that in the doxycycline group(=12.94,P<0.001).Following azithromycin therapy,all Chlamydia trachomatis positive cases in the doxycycline group became negative.Conclusions Azithromycin at a dose of 2 g can be used as a first-line treatment option for simple Chlamydia trachomatis infection in the rectum and urinary tract.

关 键 词：沙眼衣原体 直肠感染 尿道感染 阿奇霉素 多西环素 

分 类 号：R69[医药卫生—泌尿科学]