Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Drugs
Published in: Drugs 3/2000

01-09-2000 | Disease Management

Treatment of Chlamydia trachomatis Infections in Pregnant Women

Authors: Dr Joseph M. Miller, David H. Martin

Published in: Drugs | Issue 3/2000

Login to get access

Abstract

The intent of this article is to provide an overview of the epidemiology and pharmacotherapy, including cost analyses, of Chlamydia trachomatis infections in pregnant women. Chlamydia is a common sexually transmitted infection. For pregnant women, there are concerns both for the mother (post-partum endometritis, horizontal transmission) and the newborn (conjunctivitis, delayed pneumonia). Therapeutic options are restricted because of the fetus and include multi-day treatment with erythromycin, amoxicillin, clindamycin or single dose azithromycin. Clinical cure rates with these options are 86, 92, 93 and 95%, respectively.
Pharmacoeconomic analyses have been conducted to determine if the initial increase in acquisition cost of azithromycin (approximately 3-fold higher than erythromycin or amoxicillin) is offset by improvement in compliance and drug efficacy. Clindamycin has received little attention because of its expense (4-fold more than azithromycin). Analyses have been retrospective. As models incorporate more complications of failure to cure, azithromycin increasingly becomes more cost effective and is our recommended treatment.
Literature
1.
McGregor JA, French JI. Chlamydia trachomatis infection during pregnancy. Am J Obstet Gynecol 1991; 164: 1782–9PubMed
2.
Wager GP, Martin DH, Koutsky L, et al. Puerperal infectious morbidity: relationship to route of delivery and to antepartal Chlamydia trachomatis infection. Am J Obstet Gynecol 1980; 138: 1028–33PubMed
3.
Martin DH, Koutsky L, Eschenbach DA, et al. Prematurity and perinatal mortality in pregnancies complicated by maternal Chlamydial trachomatis infections. JAMA 1982; 247: 1585–8PubMedCrossRef
4.
Ryan GM, Abdella TN, McNeelley SG, et al. Chlamydia trachomatis infection in pregnancy and effects of treatment outcome. Am J Obstet Gynecol 1990; 162: 34–9PubMed
5.
Gravett MG, Nelson HP, DeRouen T, et al. Independent association of bacterial vaginosis and Chlamydia trachomatis infection with adverse pregnancy outcome. JAMA 1986; 256: 1899–903PubMedCrossRef
6.
Martin DH, Eschenbach DA, Cotch MF, et al. Double-blind placebo-controlled treatment trial of Chlamydia trachomatis endocervical infections in pregnant women. Infect Dis Obstet Gynecol 1997; 5: 10–17PubMed
7.
Marra CA, Patrick DM, Reynolds R, et al. Chlamydia trachomatis in adolescents and adults. Pharmacoeconomics 1998; 13: 191–222PubMedCrossRef
8.
Thompson SE, Washington AE. Epidemiology of sexually transmitted Chlamydia trachomatis infection. Epidemiol Rev 1983; 5: 96–123PubMed
9.
Crowley T, Horner PJ, Nelki J. Screening associated with reduced infection rates. BMJ 1994; 308: 716–7PubMedCrossRef
10.
Garland S, Gertis D, Mclnnes J. Genital Chlamydia trachomatis infection in Australia. Med J Aust 1993; 159: 60–6
11.
Orr P, Sherman E, Blanchard J, et al. Epidemiology of infection due to Chlamydia trachomatis in Manitoba, Canada. Clin Infect Dis 1994; 19(5): 876–83PubMedCrossRef
12.
Hillis SD, Nakashima A, Marchbanks PA, et al. Risk factors for recurrent Chlamydia trachomatis infections in women. Am J Obstet Gynecol 1994; 170: 801–6PubMed
13.
Black CM. Current methods of laboratory diagnosis of Chlamydia trachomatis infections. Clin Microbiol Rev 1997; 10: 160–84PubMed
14.
Marrazzo JM, Stamm WE. New approaches to the diagnosis, treatment and prevention of chlamydial infection. Curr Clin Top Infect Dis 1998; 18: 37–59PubMed
15.
Schachter J. Diagnosis of human chlamydial infections. In: Stephens SR, Byrne AI, Christinnson A, et al., editors. Chlamydial infections. Proceedings of the Ninth International Symposium on Human Chlamydial Infection; 1988: San Francisco (CA), 557-86
16.
Judson FN. Assessing the number of genital chlamydial infections in the United States. J Reprod Med 1985; 30: 269–72PubMed
17.
Heggie A, Lumicao GG, Stuart LA, et al. Chlamydia trachomatis infection in mothers and infant: a prospective study. Am J Dis Child 1981; 135:507–11PubMed
18.
Schlachter J, Grossman M, Sweet RL, et al. Prospective study of perinatal transmission of Chlamydia trachomatis. JAMA 1986; 255: 3374–7CrossRef
19.
Alexander ER, Harrison HR. Role of Chlamydia trachomatis in perinatal infection. Rev Infant Dis 1983; 5: 713–9CrossRef
20.
Center for Disease Control and Prevention. 1998 guidelines for treatment of sexually transmitted diseases. MMWR Morb Mortal Wkly Rep 1998; 47: 53–6
21.
Jones RB. New treatments for Chlamydia trachomatis. Am J Obstet Gynecol 1991; 164: 1789–93PubMed
22.
Crombleholme WR, Schlachter J, Grossman M, et al. Amoxicillin therapy for Chlamydia trachomatis in pregnancy. Obstet Gynecol 1990; 75: 752–6PubMed
23.
Alary M, Joly JR, Moutquin JM, et al. Randomized comparison of amoxicillin and erythromycin in the treatment of genital chlamydial infection in pregnancy. Lancet 1994; 344: 1461–5PubMedCrossRef
24.
Magat AH, Alger LS, Nagey DA, et al. Double-blind randomized study comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy. Obstet Gynecol 1993; 81: 745–9PubMed
25.
Turrentine MA, Troyer L, Gonik B. Randomized prospective study comparing erythromycin, amoxicillin and clindamycin for the treatment of Chlamydia trachomatis in pregnancy. J Infect Dis Obstet Gynecol 1995; 2: 205–9CrossRef
26.
Silverman NS, Sullivan M, Hochman M, et al. A randomized, prospective trial comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy. Am J Obstet Gynecol 1994; 170: 829–32PubMed
27.
Alger LS, Lovchik JC. Comparative efficacy of clindamycin versus erythromycin in eradication of antenatal Chlamydia trachomutis. Am J Obstet Gynecol 1991; 165: 375–81PubMed
28.
Adair CD, Gunter M, Stoval TG, et al. Chlamydia in pregnancy: a randomized trial of azithromycin and erythromycin. Obstet Gynecol 1998; 91: 165–8PubMedCrossRef
29.
Bush MR, Rosa C. Azithromycin and erythromycin in the treatment of cervical chlamydial infection during pregnancy. Obstet Gynecol 1994; 84: 61–3PubMed
30.
Wehbeh HA, Ruggeirio RM, Shahem S, et al. Single-dose azithromycin for Chlamydia in pregnant women. J Reprod Med 1998; 43(6): 509–14PubMed
31.
Rosenn M, Macones GA, Silverman N. A randomized trial of erythromycin and azithromycin for the treatment of chlamydia infection in pregnancy [abstract]. Am J Obstet Gynecol 1996; 174: 410CrossRef
32.
Turrentine MA, Newton ER. Amoxicillin or erythromycin for the treatment of antenatal chlamydial infection: a metaanalysis. Obstet Gynecol 1995; 86: 1021–5PubMedCrossRef
33.
Miller Jr JM. Efficacy and tolerance of single-dose azithromycin for treatment of chlamydial cervicitis during pregnancy. Infect Dis Obstet Gynecol 1995; 3: 189–92PubMedCrossRef
34.
Lea AP, Lamb HM. Azithromycin: a pharmacoeconomic review of its use as a single-dose regimen in the treatment of uncomplicated urogenital Chlamydia trachomatis infections in women. Clin Pharmacokinet 1997; 12: 596–611
35.
Bachmann LH, Stephens J, Richey CM, et al. Measured versus self-reported compliance with doxycycline therapy for Chlamydia associated with syndromes [abstract]. 26th Interscience Conference on Antimicrobial Agents and Chemotherapy: 1996 Sep 15–18: New Orleans (LA), 256
36.
Katz BP, Zwickl BW, Caine MA, et al. Compliance with antibiotic therapy for Chlamydia trachomatis and Neisseria gonorrhoeae. Sex Transm Dis 1992; 19: 351–4PubMedCrossRef
37.
Brookhoff D. Compliance with doxycycline therapy for outpatient treatment of pelvic inflammatory disease. South Med J 1994; 87: 1088–91CrossRef
38.
Genc M, Mordh P-A. Cost-effective treatment of uncompleted gonorrhea including co-infection with Chlamydia trachomatis. Pharmacoeconomics 1997; 12: 374–83PubMedCrossRef
39.
Edwards M, Rainwater K, Carter S, et al. Comparison of azithromycin and erythromycin for chlamydia cervicitis in pregnancy [abstract]. Am J Obstet Gynecol 1994; 170: 419
40.
41.
Allaire AD, Huddleston JF, Graves WL, et al. Initial and repeat screening for Chlamydia trachomutis during pregnancy. Infect Dis Obstet Gynecol 1998; 6: 116–22PubMed
42.
Fitzgerald MR, Welch J, Robinson AJ, et al. Clinical guidelines and standards for the management of uncomplicated genital chlamydial infection. Int J STD AIDS 1998; 9: 253–62PubMedCrossRef
43.
Howell MR, Kassler WJ, Haddix A. Partner notification to prevent pelvic inflammatory disease in women: Cost-effectiveness of two strategies. Sex Transm Dis 1997; 24:287–92PubMedCrossRef
44.
Ramstedt K, Forssman L, Johannisson G. Contact tracing in the control of genital Chlamydia trachomatis infection. Int J STD AIDS 1991; 2: 116–8PubMed
45.
Kissinger P, Brown R, Reed K, et al. The effectiveness of patient delivered partner medication for preventing recurrent Chlamydial trachomutis. Sex Transm Infect 1997; 5: 10–17
46.
Hueston WJ, Lenhart JG. A decision analysis to guide antibiotic selection for Chlamydia infection during pregnancy. Arch Fam Med 1997; 6: 551–5PubMedCrossRef
47.
Nuovo J, Melnikow J, Paliescheskey M, et al. Cost-effectiveness analysis of five different antibiotic regimens for the treatment of uncomplicated Chlamydia trachomatis cervicitis. J Am Board Fam Pract 1995; 8: 7–16PubMed
48.
Magid D, Douglas JM Jr, Schwartz JS. Doxycycline compared with azithromycin for treating women with genital Chlamydia trachomatis infections: an incremental cost effectiveness. Ann Intern Med 1996; 124: 359–99
49.
Haddix AC, Hillis SD, Kassler WJ. The cost effectiveness of azithromycin for Chlamydia trachomatis infection in women. Sex Transm Dis 1995; 22: 274–80PubMedCrossRef
50.
Marra F, Marra CA, Patrick DM. Cost effectiveness analysis of azithromycin and doxycycline for Chlamydia trachomatis infection in women: a Canadian perspective. Can J Infect Dis 1997; 8: 202–8PubMed
51.
Harrison HR, Alexander ER, Weinstein L, et al. Cervical Chlamydia trachomutis and mycoplasmal infections in pregnancy: epidemiology and outcomes. JAMA 1983; 250: 1721–7PubMedCrossRef
52.
Sweet RL, Landers DV, Walker C, et al. Chlamydia trachomatis infection and pregnancy outcome. Am J Obstet Gynecol 1987; 156: 824–33PubMed
53.
Rivlin ME, Morrison JC, Grossman JH III. Comparison of pregnancy outcome between treated and untreated women with chlamydial cervicitis. J Miss State Med Assoc 1997; 38(11): 404–7PubMed
54.
Martin DS, Pastorek JG, Faro S. In vitro and in vivo activity of parenterally administered beta-lactam antibiotics against Chlamydia trachomatis. Sex Transm Dis 1986; 13: 81–7PubMedCrossRef
Metadata
Title
Treatment of Chlamydia trachomatis Infections in Pregnant Women
Authors
Dr Joseph M. Miller
David H. Martin
Publication date
01-09-2000
Publisher
Springer International Publishing
Published in
Drugs / Issue 3/2000
Print ISSN: 0012-6667
Electronic ISSN: 1179-1950
DOI
https://doi.org/10.2165/00003495-200060030-00006

Other articles of this Issue 3/2000

Drugs 3/2000 Go to the issue

Adis New Drug Profile

Nateglinide

Adis Drug Evaluation

Desirudin

Leading Article

Combination Chemotherapy for Hepatitis B Virus

Adis New Drug Profile

Nateglinide

Leading Article

Potential of Substance P Antagonists as Antiemetics

Adis Drug Evaluation

Meropenem