Trends in Chlamydia trachomatis Treatment Prescribing Practices in King County, Washington, 2010 - 2018

Abstract

Abstract Background In 2021, national Chlamydia trachomatis (CT) treatment guidelines changed from recommending either azithromycin (1 gram; single dose) or doxycycline (100 mg twice daily for 7 days) to recommending only doxycycline as first-line treatment. The distribution and trends in CT prescribing practices prior to the guidelines change is largely unknown. Methods We conducted a trends analysis using Washington STD surveillance data. We included all female cases of urogenital CT aged >15 years who resided in King County and were diagnosed between 2010 and 2018. Surveillance data included information on demographics, sexual history, clinical features, diagnosing facility (e.g., emergency department, family planning), and treatment regimen. We conducted descriptive analyses to examine trends in prescribing practices over time and by facility type. We used Poisson regression to examine the association between CT case characteristics and receipt of receipt of azithromycin. Results There were 36,830 cases of female urogenital CT during the study period. The percent of cases receiving azithromycin increased significantly from 86% in 2010 to 94% in 2018; the percent receiving doxycycline decreased from 13% to 5%. Five of the eight facility types prescribed azithromycin to >95% of CT cases by 2018. Cases who were younger or cases of color were more likely to receive azithromycin (versus doxycycline) compared to older and White cases respectively. Conclusions A substantial shift in CT prescribing practices will be needed to adhere to new CT treatment guidelines. Our findings highlight the need for targeted provider education and training to encourage the transition to doxycycline use.