Trends in chlamydia prescribing practices after changes to national treatment guidelines in the United States, 2016-2023.

Abstract

Background: In 2021 the US Centers for Disease Control and Prevention revised Chlamydia trachomatis (CT) treatment guidelines to recommend only doxycycline as first line-therapy, instead of recommending either azithromycin or doxycycline. The extent to which this recommended change has been translated into practice is unknown.

Methods: We used 2016-2023 MarketScan data (national convenience sample of insurance claims from individuals with employer-sponsored insurance and Medicaid beneficiaries from 8-12 states) to identify encounters of CT diagnoses for individuals aged 15-60 years old who were treated with doxycycline or azithromycin within 14 days after diagnosis. We examined trends in doxycycline treatment before and after the 2021 change to the treatment guidelines. We compared receipt of doxycycline in 2022 by characteristics and facility/provider type.

Results: We included 154,200 encounters. Between 2016-2020, the percentage prescribed doxycycline remained stable at 17%. In 2021 and 2022, the percentage prescribed doxycycline increased to 37.6% and 57.1%, respectively. In 2022, women were significantly less likely to receive doxycycline compared to men (commercial: 55.3% vs. 76.5%; Medicaid: 48.2% vs. 71.5%), and people under age 25 were significantly less likely to receive doxycycline compared to those >25 (commercial: 61.0% vs. 67.4%; Medicaid: 50.8% vs. 57.4%). People treated in an emergency department were significantly more likely to receive doxycycline compared to other clinicians/facility types.

Conclusions: There has been rapid uptake of the new CT treatment guidelines; however, those at risk of acquiring CT (women and those aged <25 years) are the least likely to receive recommended treatment.