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CHLORTETRACYCLINE CLINICAL APPLICATIONS THERAPEUTIC USES C. CHLAMYDIAL INFECTIONS 1. OVERVIEW: FDA APPROVAL: Adult, no; pediatric, no EFFICACY: Adult, possibly effective; pediatric, possibly effective DOCUMENTATION: Adult, fair; pediatric, fair 2. SUMMARY: - Chlortetracycline alone or in combination therapy has been effective in treatment of chlamydial infections - Neonatal ocular chlamydial infection best treated with chlortetracycline/erythromycin combination - Controlled studies are lacking 3. ADULT: a. In an open study of 69 men with chlamydia-positive nonspecific or post-gonococcal urethritis, chlortetracycline 250 milligrams four times a day oral dose was administered for either 4 to 10 days or 12 to 18 days. The total number of resolved cases was 71%, with a better score for the long-term treatment (80%) than the short-term (59%) group. In four cases in the short-term group (14%), the relapse with re-isolation of C trachomatis was observed but without significant difference. The minimum inhibitory concentration (MIC) has ranged from 0.02 to 1 microgram per milliliter (Terho, 1978). b. In an open study, 75 chlamydia-positive women were treated with triple tetracycline combination: chlortetracycline hydrochloride 115.4 milligrams (mg) plus tetracycline hydrochloride 115.4 mg plus demeclocycline hydrochloride 69.2 mg (Deteclo(R) 300 mg) twice daily for 7 or 21 days. Chlamydia was eradicated from the female genital tract during both treatment periods (Waugh & Nayyar, 1977). c. For More Information: See Drug Consult reference: "CHLAMYDIAL INFECTIONS 1998 CDC GUIDELINES" See Drug Consult reference: "CHLAMYDIA-INDUCED URETHRITIS, CERVICITIS, CONJUNCTIVITIS, PROCTITIS DRUG OF CHOICE" See Drug Consult reference: "CHLAMYDIA TRACHOMATIS DRUG OF CHOICE" 4. PEDIATRIC: a. Neonatal ocular chlamydial infection can be adequately treated with chlortetracycline 1% eye ointment in association with systemic erythromycin (30 milligrams/kilogram/day) for 21 days. Since chlamydial ophthalmic neonatal infection is acquired during birth, both the mother and the father should be investigated and treated (Ridgway & Oriel, 1977). b. In a small study, chlortetracycline 1% eye ointment monotherapy was effective in only 3 of 6 infants; the infection in non-responders resolved with the addition of systemic erythromycin (40 milligrams (mg) per kilogram per day) for 2 weeks. No failures were observed in 4 adult patients treated with chlortetracycline 1% eye ointment plus erythromycin 500 mg twice daily for 2 weeks (Molgaard et al, 1983). c. For More Information: See Drug Consult reference: "CHLAMYDIA-INDUCED URETHRITIS, CERVICITIS, CONJUNCTIVITIS, PROCTITIS DRUG OF CHOICE