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. 2000;1998(2):CD000054.
doi: 10.1002/14651858.CD000054.

Interventions for treating genital chlamydia trachomatis infection in pregnancy

P Brocklehurst  1 , G Rooney
Affiliations

Interventions for treating genital chlamydia trachomatis infection in pregnancy

P Brocklehurst et al. Cochrane Database Syst Rev. 2000.

Abstract

Background: Chlamydia trachomatis is a sexually transmitted infection. Mother-to-child transmission can occur at the time of birth and may result in ophthalmia neonatorum or pneumonitis in the newborn.

Objectives: The objective of this review was to assess the effects of antibiotics in the treatment of genital infection with Chlamydia trachomatis during pregnancy with respect to neonatal and maternal morbidity.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (Cochrane Library issue 1, 1999).

Selection criteria: Randomised trials of any antibiotic regimen compared with placebo or no treatment or alternative antibiotic regimens in pregnant women with genital Chlamydia trachomatis infection.

Data collection and analysis: Trial quality assessments and data extraction were done independently by two reviewers. Study authors were contacted for additional information.

Main results: Eleven trials were included. Trial quality was generally good. Amoxycillin appeared to be as effective as erythromycin in achieving microbiological cure (odds ratio 0.54, 95% confidence interval 0.28 to 1.02). Amoxycillin was better tolerated than erythromycin (odds ratio 0.16, 95% confidence interval 0.09 to 0.30). Clindamycin and azithromycin also appear to be effective, although the numbers of women included in trials are small.

Reviewer's conclusions: Amoxycillin appears to be an acceptable alternative therapy for the treatment of genital chlamydial infections in pregnancy when compared with erythromycin. Clindamycin and azithromycin may be considered if erythromycin and amoxycillin are contra-indicated or not tolerated.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Antibiotic therapy versus placebo or no therapy, Outcome 1 Neonatal death.
1.4
1.4. Analysis
Comparison 1 Antibiotic therapy versus placebo or no therapy, Outcome 4 Maternal postpartum endometritis.
1.5
1.5. Analysis
Comparison 1 Antibiotic therapy versus placebo or no therapy, Outcome 5 Delivery < 37 weeks.
1.6
1.6. Analysis
Comparison 1 Antibiotic therapy versus placebo or no therapy, Outcome 6 Failure to achieve microbiological cure.
1.7
1.7. Analysis
Comparison 1 Antibiotic therapy versus placebo or no therapy, Outcome 7 Side‐effects sufficient to stop treatment.
1.8
1.8. Analysis
Comparison 1 Antibiotic therapy versus placebo or no therapy, Outcome 8 Side‐effects not sufficient to stop treatment.
2.6
2.6. Analysis
Comparison 2 Amoxicillin versus erythromycin, Outcome 6 Failure to achieve microbiological cure.
2.7
2.7. Analysis
Comparison 2 Amoxicillin versus erythromycin, Outcome 7 Side‐effects sufficient to stop treatment.
2.8
2.8. Analysis
Comparison 2 Amoxicillin versus erythromycin, Outcome 8 Side‐effects not sufficient to stop treatment.
3.1
3.1. Analysis
Comparison 3 Azithromycin versus erythromycin, Outcome 1 Neonatal death.
3.5
3.5. Analysis
Comparison 3 Azithromycin versus erythromycin, Outcome 5 Delivery < 37 weeks.
3.6
3.6. Analysis
Comparison 3 Azithromycin versus erythromycin, Outcome 6 Failure to achieve microbiological cure.
3.7
3.7. Analysis
Comparison 3 Azithromycin versus erythromycin, Outcome 7 Side‐effects sufficient to stop treatment.
3.8
3.8. Analysis
Comparison 3 Azithromycin versus erythromycin, Outcome 8 Side‐effects not sufficient to stop treatment.
3.9
3.9. Analysis
Comparison 3 Azithromycin versus erythromycin, Outcome 9 Fetal anomalies.
4.6
4.6. Analysis
Comparison 4 Clindamycin versus erythromycin, Outcome 6 Failure to achieve microbiological cure.
4.7
4.7. Analysis
Comparison 4 Clindamycin versus erythromycin, Outcome 7 Side effects sufficient to stop treatment.
4.8
4.8. Analysis
Comparison 4 Clindamycin versus erythromycin, Outcome 8 Side effects not sufficient to stop treatment.
5.7
5.7. Analysis
Comparison 5 Clindamycin versus amoxicillin, Outcome 7 Side‐effects sufficient to stop treatment.
5.8
5.8. Analysis
Comparison 5 Clindamycin versus amoxicillin, Outcome 8 Side‐effects not sufficient to stop treatment.
See this image and copyright information in PMC

References

References to studies included in this review

Adair 1998 {published data only}
    1. Adair CD, Gunter M, Stovall TG, Mcelroy G, Veille JC, Ernest JM. Chlamydia in pregnancy: a randomized trial of azithromycin and erythromycin. Obstetrics & Gynecology 1998;91:165‐8. - PubMed
Alary 1994 {published data only}
    1. Alary M, Joly JR, Moutquin JM, Mondor M, Boucher M, Fortier A, et al. Randomised comparison of amoxycillin and erythromycin in treatment of genital chlamydial infection in pregnancy. Lancet 1994;344:1461‐5. - PubMed
Alger 1991 {published and unpublished data}
    1. Alger LS, Lovchik JC. Comparative efficacy of clindamycin versus erythromycin in eradication of antenatal Chlamydia trachomatis. American Journal of Obstetrics and Gynecology 1991;165:375‐81. - PubMed
Bell 1982 {published data only}
    1. Bell TA, Sandstrom IK, Eschenbach DA, Hummel D, Kuo C, Wang S, et al. Treatment of Chlamydia trachomatis in pregnancy with amoxicillin. In: Mardh PA editor(s). Chlamydial infections. Elsevier Biomedical Press, 1982:221‐4.
Bush 1994 {published data only}
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Edwards 1996 {published data only}
    1. Edwards MS, Newman RB, Carter SG, LeBoeuf FW, Menard MK, Rainwater KP. Randomized clinical trial of azithromycin for the treatment of Chlamydia cervicitis in pregnancy. Infectious Diseases in Obstetrics & Gynecology 1996;4:333‐7. - PMC - PubMed
Magat 1993 {published data only}
    1. Magat AH, Alger LS, Nagey DA, Hatch V, Lovchik JC. Double‐blind randomized study comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy. Obstetrics & Gynecology 1993;81:745‐749. - PubMed
Martin 1997 {published data only}
    1. Martin DH, Eschenbach DA, Cotch MF, Nugent RP, Roa AV, Klebanoff MA, et al. Double‐blind placebo‐controlled treatment trial of Chlamydia trachomatis endocervical infections in pregnant women. Infectious Diseases in Obstetrics & Gynecology 1997;5:10‐17. - PMC - PubMed
Rosenn 1995 {published data only}
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    1. Rosenn MF, Macones GA, Silverman NS. Randomized trial of erythromcyin and azithromycin for treatment of chlamydial infection in pregnancy. Infectious Diseases in Obstetrics & Gynecology 1995;3:241‐4. - PMC - PubMed
Silverman 1994 {published data only}
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    1. Silverman NS, Sullivan M, Hochman M, Womack M, Jungkind DL. A randomized, prospective trial comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy. American Journal of Obstetrics and Gynecology 1994;170:829‐32. - PubMed
Turrentine 1995 {published data only}
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References to studies excluded from this review

Crombleholme 1990 {published data only}
    1. Crombleholme WR, Schachter J, Grossman M, Landers DV, Sweet RL. Amoxicillin therapy for Chlamyida trachomatis in pregnancy. Obstetrics & Gynecology 1990;75:752‐756. - PubMed
McGregor 1990 {published data only}
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Thomason 1990 {published data only}
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References to studies awaiting assessment

El‐Shourbagy 2011 {published data only}
    1. El‐Shourbagy MAA, El‐Refaie TA, Sayed KKA, Wahba KAH, El‐Din ASS, Fathy MM. Impact of seroconversion and antichlamydial treatment on the rate of pre‐eclampsia among Egyptian primigravidae. International Journal of Gynecology & Obstetrics 2011;113(2):137‐40. - PubMed
Jacobson 2001 {published data only}
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Kacmar 2001 {published data only}
    1. Kacmar J, Cheh E, Montagno A, Peipert JF. A randomized trial of azithromycin versus amoxicillin for the treatment of Chlamydia trachomatis in pregnancy. Infectious Diseases in Obstetrics & Gynecology 2001;9:197‐202. - PMC - PubMed
Nadafi 2005 {published data only}
    1. Nadafi M, Abdali KH, Parsanejad ME, Rajaee‐Fard AR, Kaviani M. A comparison of amoxicillin and erythromycin for asymptomatic chlamydia trachomatis infection in pregnancy. International Journal of Gynecology & Obstetrics 2005;90(2):142‐3. - PubMed
Wehbeh 1996 {published data only}
    1. Wehbeh H, Ruggiero R, Ali Y, Lopez G, Shahem S, Zarou D. A randomized clinical trial of a single dose of zithromycin in treatment of chlamydia amongst pregnant women. American Journal of Obstetrics and Gynecology 1996;174(1 Pt 2):361.
Wehbeh 1998 {published data only}
    1. Wehbeh HA, Ruggeirio RM, Shahem S, Lopez G, Ali Y. Single‐dose azithromycin for chlamydia in pregnant women. Journal of Reproductive Medicine 1998;43(6):509‐14. - PubMed
Zul'karneev 1998 {published data only}
    1. Zul'karneev RSh, Kalinin IuT, Afanas'ev SS, Rubal'skii OV, Denisov LA, Vorob'ev AA, Sorokin SV. Use of recombinant alpha2‐interferon and a complex immunoglobulin preparation for the treatment of chlamydiosis in pregnancy women. Zhurnal Mikrobiologii, Epidemiologii i Immunobiologii 1998, (2):115‐8. - PubMed

Additional references

Kuo 1977
    1. Kuo CC, Wang SP, Grayston TJ. Antimicrobial activity of several antibiotics and a sulfonamide against Chlamydia trachomatis organisms in cell culture. Antimicrobial Agents and Chemotherapy 1977;12:80‐3. - PMC - PubMed

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