COMPLIANCE WITH DOXYCYCLINE THERAPY IN SEXUALLY-TRANSMITTED DISEASES CLINICS

Objective: To determine rates of compliance with doxycycline therapy f or patients attending two inner city sexually transmitted diseases (ST D) clinics using the MEMS (Medication Event Monitoring System) technol ogy (Aprex Corporation, Fremont, CA). Design: An observational study. Setting: Two STD clinics in Brooklyn, New York and Birmingham, Alabama . Patients: Patients warranting doxycycline as antichlamydial therapy by usual clinical criteria (e.g., documented chlamydial infections, go nococcal urethritis, mucopurulent cervicitis) were enrolled consecutiv ely from both clinics into four separate categories according to gende r and the presence or absence of symptoms: symptomatic men (77), asymp tomatic men (30), symptomatic women (83), asymptomatic women (33). Int ervention: In the clinic area, patients were given their doxycycline i n standard 30-dram medication bottles fitted with the MEMS cap, which is capable of recording the date and time of each bottle opening and c losing. This information was then retrieved using a software program d eveloped by the manufacturer. Patients were instructed to return the b ottle and cap at the completion of therapy. Efforts were made to conta ct those who did not return their bottles by both telephone and mail. Outcome Measures: Bottle openings as recorded by the MEMS were conside red to represent use of medication. Patients were considered strictly compliant with prescription instructions if bottle openings and closin gs occurred at least twice daily for 6 consecutive days. Noncompliance was defined as initially opening the medication more than 48 hours af ter leaving the clinic or opening the bottle less than once daily for 5 consecutive days. Usage between these extremes was classified as int ermediate. Results: Eighty percent of 223 patients enrolled completed the study by returning their bottles. The rate of strict compliance wi th prescription instruction was 25%. The rate of noncompliance was 24% . Fifty-one percent used some intermediate amount of medication. There was no statistical difference in compliance by gender, presence or ab sence off symptoms, or site of enrollment. Conclusions: Few patients a dministered doxycycline in an STD clinic can be expected to take medic ation precisely as prescribed. Although most probably take enough to e radicate uncomplicated chlamydial infections, a sizable portion can be expected to use an inadequate amount of medication. This may contribu te to persistence of genital chlamydia infections in the community.