Azithromycin

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.

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

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.

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).

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.

The emission of contaminants of emerging concern (CECs) from wastewater treatment plants has been extensively studied; however, less attention has been paid to municipal solid waste treatment plants (MSWTPs), which can also be a potential source for CECs into surface water (SW) and groundwater (GW) ecosystems. In this work, the environmental impact of a MSWTP located in the province of Castelló, Spain, was studied along a period of ten years (from 2012 to 2022). A total of 173 water samples (including SW and GW) collected from the surrounding of this plant were monitored for 93 compounds (pharmaceuticals and pesticides) by using liquid chromatography coupled to tandem mass spectrometry with triple quadrupole. This study reveals the presence of several pharmaceuticals (e.g. primidone, gabapentin, azithromycin, clarithromycin, tramadol), particularly in GW samples collected near areas related to composting and storage of biostabilized material. The presence of antibiotic residues in GW raises concerns about the potential development of antimicrobial resistance. In addition, agricultural activities in the study area emerge as potential contributor to GW pollution by pesticides, as the MSWTP is located in an important agricultural area where citrus is the predominant crop. Some compounds that are currently prohibited for agricultural use (e.g. atrazine, simazine, chlorpyrifos) were also found, which highlights the importance of continuing their monitoring to assess their long-term environmental impacts. Several pesticide and pharmaceutical compounds exceeded the threshold values established by the EU groundwater directive. Therefore, a hazard assessment for GW ecosystems and for humans drinking contaminated GW resources was conducted. Our data indicated that some organophosphate insecticides (i.e., chlorpyrifos, carbofuran, pyridaphention) may pose high risks for groundwater crustaceans, while the risks for the human population were considered to be very low.