Impact of doxycycline discharge kits on appropriate treatment of sexually transmitted infections among patients in the ED

Background: Chlamydia trachomatis is the most prevalent, reportable sexually transmitted infection (STI) in the United States. In 2021, the Centers for Disease Control and Prevention (CDC) updated treatment recommendations from a single azithromycin 1000 mg dose to doxycycline 100 mg twice daily for seven days for the treatment of chlamydia infections. In response to changes in treatment recommendations and addressing patient barriers to treatment, pharmacists at an urban, academic medical center collaborated with the state health department to create doxycycline kits dispensed upon emergency department (ED) discharge.

Objective: To evaluate if ED doxycycline discharge kits improve appropriate and timely treatment of chlamydia.

Methods: This was a single center, retrospective, chart review study of adult patients with a positive chlamydia test while seen in the ED between September 1, 2021 and September 30, 2023. Patients with a listed allergy to doxycycline and those who were incarcerated and/or pregnant were excluded. The primary outcome was appropriate, guideline recommended chlamydia treatment before and after doxycycline discharge kit implementation. Secondary outcomes included rate of ED return visits within 90 days for STI-related complaints, time to treatment in those who received a prescription for doxycycline versus doxycycline kit, and rate of doxycycline initiation via emergency medicine (EM) pharmacist culture call-back list.

Results: A total of 170 patients were enrolled in the study, 72 patients in the pre-kit group and 98 patients in the post-kit group. Significantly more patients received appropriate treatment in the post kit group (pre-kit (45.8 %) vs post-kit (69.1 %); CI 95 % 2.63 (1.4-5.0); p = 0.002). Time to definitive treatment was significantly shorter in the post-kit group (22.7 h pre-kit vs 1.3 h post-kit; p < 0.001).

Conclusions: Doxycycline discharge kits significantly increased guideline-directed treatment and decreased time-to-treatment for chlamydia in the ED population at an urban academic medical center.