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This drug doesn't win on price point.


Azithromycin doesn't beat doxycycline in the treatment of pelvic inflammatory disease (PID) on at least one count ("Azithromycin for PID beats doxycycline on all counts," J Fam Pract. 2007;56:1006-1009.)

For a cash-paying patient, the recommended dose of azithromycin will cost approximately $42 (local pharmacy, as of December 4, 2007) to $60, while doxycycline will run between $4 (at pharmacies with special pricing on some generics) and $10. (1) The cost-effectiveness assessment cited in the article (2) based their analysis on prices of $18 vs $5 for the respective drugs, using wholesale acquisition costs in 1996.


(1.) Available at: Accessed December 4, 2007.

(2.) Magid D, Douglas JM, Schwartz JS. Doxycycline compared with azithromycin for treating women with genital Chlamydia trachomatis infections: an incremental cost-effectiveness analysis. Ann Intern Med. 1996;124:389-399.

William Hay, MD

University of Nebraska Medical Center, Omaha

Drs. Rowland and Ewigman respond

You make a great point. For the individual patient who is short on cash, a cost-effective analysis based on old cost data is not particularly relevant. Doxycycline does work for the outpatient management of PID, just not quite as well as azithromycin, so it seems to us like a perfectly good choice when personal circumstances dictate. The cost difference is no doubt a relevant issue for many of our patients, and we appreciate you taking the time to point out this omission in our PURL.

Kate Rowland, MD

Bernard Ewigman, MD MSPH

Department of Family Medicine

The University of Chicago


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Title Annotation:LETTERS
Author:Hay, William; Rowland, Kate; Ewigman, Bernard
Publication:Journal of Family Practice
Article Type:Letter to the editor
Date:Apr 1, 2008
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