Treatment Failure of Chlamydial Infection in Males and Females in Youth Correctional Facilities
Condition: Chlamydial Infection
MeSH terms: Infections; Communicable Diseases; Chlamydia Infections
Study type: Interventional
Phase: Phase 3

Summary: 
      Chlamydia is a common infection among youth and can be given from one person to another
      during sex. Many people who have chlamydia have no signs of infection at all, but can pass
      the infection to anyone they have sex with. If not treated, chlamydia can lead to serious
      health problems. This study will look at how well medicines given for chlamydia infection
      work. The study requires 306 evaluable subjects, chlamydia-positive, males and non-pregnant
      females, ages 12-21, living in long-term, gender-segregated youth correctional facilities.
      Participants will be assigned to receive either doxycycline (2 times per day, by mouth, for 7
      days) or azithromycin (1 single dose by mouth). Study procedures will include collection of
      at least 3 urine samples to test for chlamydia. Study visits will occur during initial
      enrollment in the study, day 28 after starting treatment, and day 67. Participants will be
      involved in study related procedures for up to 67 days.
    

Detailed description: 
      Genital chlamydia is a public health concern. The World Health Organization (WHO) estimates
      that 90 million of all new cases of sexually transmitted diseases (STDs) per year are caused
      by Chlamydia (C.) trachomatis. In the United States alone, approximately 3 million new cases
      of chlamydia are reported yearly, and the costs associated with their management and
      complications exceed $2 billion. Unfortunately, at least 75 percent of females with chlamydia
      are asymptomatic, and unless the infection is detected through chlamydia testing (screening),
      their infection may be transmitted to others or lead to complications. The Centers of Disease
      Control and Prevention (CDC) recommends either azithromycin 1 gram (gm) by mouth (PO) once or
      doxycycline 100 milligrams (mg) PO twice daily (BID) for 7 days as co-equal therapies for
      uncomplicated chlamydia. A secondary aim will be to determine demographic predictors of
      chlamydia treatment failure following azithromycin or doxycycline treatment, and to explore
      clinical parameters, which distinguish those with persistent infection. The study design of
      this Phase III trial will address major limitations of prior chlamydia efficacy studies and
      the findings will reveal both the true efficacy of azithromycin and doxycycline in
      uncomplicated chlamydia in adolescents and the factors that predict treatment failure. This
      study is designed primarily to determine the frequency of chlamydia treatment failure
      following either azithromycin or doxycycline regimens and to evaluate whether the efficacy of
      the azithromycin regimen is inferior to the doxycycline regimen. Both drugs are Food and Drug
      Administration (FDA) approved for use in the U.S. The study will enroll 650 males and females
      age 12-21 years in good health (based on vital signs and provider's clinical evaluation
      documented in medical records) who are residing in long-term gender-segregated (not co-ed)
      youth correctional facilities (YCFs) (usual stay >3 weeks) and who are identified as
      chlamydia-infected would comprise the study population until 306 evaluable subjects are
      obtained . Only individuals who have a positive chlamydia screening test are enrolled, and
      those with negative screening tests are excluded. Consenting chlamydia-positive subjects at
      the enrollment visit (study visit 1) will be enrolled, asked to provide demographic data, to
      provide a first-void urine sample (not a mid-stream specimen) for repeat chlamydia testing
      with Gen-Probe (GP) AC2 (for verification of chlamydia), and then randomized to 1 of 2
      treatment arms (190 153 subjects per arm): doxycycline 100 mg PO BID for 7 days or
      azithromycin 1 gm PO single dose. Both therapies are given as directly observed, and side
      effects are evaluated at the first follow-up visit (day 28 after study drug initiation). If a
      subject who's GP AC2 from the enrollment treatment visit returns negative for C. trachomatis,
      they will be categorized as unevaluable and will be removed from the study, then the site
      investigator will determine whether the subject will complete this treatment or will receive
      other therapy. Subjects whose GP AC2 at the enrollment treatment visit is positive for C.
      trachomatis will then be asked to provide a first-void urine sample for repeat chlamydia
      testing with GP AC2 at 28- and 67-days after study drug initiation [corresponding to the
      first follow-up visit (study visit 2) and second follow-up visit (study visit 3),
      respectively].
    

Intervention name(s): Azithromycin; Doxycycline
Intervention type(s): Drug; Drug
Intervention description(s): FDA approved, a 1 gm single dose, two 500 mg tablets.; FDA approved, a 100 mg capsule twice a day for 7 days.
Intervention MeSH terms: Azithromycin; Doxycycline
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Chlamydia trachomatis, Chlamydia, Doxycycline, Azithromycin