Appropriate treatment of chlamydial proctitis includes which of the following?

a. Tetracycline 500 mg QID

d. Erythromycin 500 mg QID

C trachomatis is the most common cause of sexually transmitted disease in the United States, affecting 4 million Americans each year. Proctoscopy reveals a picture of nonspecific proctitis with friable, granular, and edematous mucosa. Immunofluorescent microscopy provides an accurate and a rapid diagnosis. Treatment includes tetracycline hydrochloride, 500 mg by mouth four times daily for 7 days, or doxycycline, 100 mg by mouth twice daily for 7 days. For patients in whom tetracyclines are contraindicated, erythromycin base or stearate, 500 mg by mouth four times daily for 7 days, or erythromycin ethylsuccinate, 800 mg by mouth four times daily for 7 days, may be used. Two new drugs have been approved by the FDA for the treatment of chlamydia—Azithromycin, 1 gm orally in a single dose, and Ofloxacin, 300 mg orally two times a day for 7 days. A substantial advantage of Azithromycin, in comparison with all other therapies, is that a single dose is effective; this antimicrobial may prove most useful in situations in which compliance with a seven day regimen of another antimicrobial cannot be ensured. In view of the high efficacy of tetracycline and doxycycline, cost also should be considered when selecting a treatment regimen.