Drugs

, Volume 60, Issue 3, pp 597–605

Treatment of Chlamydia trachomatis Infections in Pregnant Women

  • Joseph M. Miller
  • David H. Martin
Disease Management

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.

References

  1. 1.
    McGregor JA, French JI. Chlamydia trachomatis infection during pregnancy. Am J Obstet Gynecol 1991; 164: 1782–9PubMedGoogle Scholar
  2. 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: 1028–33PubMedGoogle Scholar
  3. 3.
    Martin DH, Koutsky L, Eschenbach DA, et al. Prematurity and perinatal mortality in pregnancies complicated by maternal Chlamydial trachomatis infections. JAMA 1982; 247: 1585–8PubMedCrossRefGoogle Scholar
  4. 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: 34–9PubMedGoogle Scholar
  5. 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: 1899–903PubMedCrossRefGoogle Scholar
  6. 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: 10–17PubMedGoogle Scholar
  7. 7.
    Marra CA, Patrick DM, Reynolds R, et al. Chlamydia trachomatis in adolescents and adults. Pharmacoeconomics 1998; 13: 191–222PubMedCrossRefGoogle Scholar
  8. 8.
    Thompson SE, Washington AE. Epidemiology of sexually transmitted Chlamydia trachomatis infection. Epidemiol Rev 1983; 5: 96–123PubMedGoogle Scholar
  9. 9.
    Crowley T, Horner PJ, Nelki J. Screening associated with reduced infection rates. BMJ 1994; 308: 716–7PubMedCrossRefGoogle Scholar
  10. 10.
    Garland S, Gertis D, Mclnnes J. Genital Chlamydia trachomatis infection in Australia. Med J Aust 1993; 159: 60–6Google Scholar
  11. 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): 876–83PubMedCrossRefGoogle Scholar
  12. 12.
    Hillis SD, Nakashima A, Marchbanks PA, et al. Risk factors for recurrent Chlamydia trachomatis infections in women. Am J Obstet Gynecol 1994; 170: 801–6PubMedGoogle Scholar
  13. 13.
    Black CM. Current methods of laboratory diagnosis of Chlamydia trachomatis infections. Clin Microbiol Rev 1997; 10: 160–84PubMedGoogle Scholar
  14. 14.
    Marrazzo JM, Stamm WE. New approaches to the diagnosis, treatment and prevention of chlamydial infection. Curr Clin Top Infect Dis 1998; 18: 37–59PubMedGoogle Scholar
  15. 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), 557-86Google Scholar
  16. 16.
    Judson FN. Assessing the number of genital chlamydial infections in the United States. J Reprod Med 1985; 30: 269–72PubMedGoogle Scholar
  17. 17.
    Heggie A, Lumicao GG, Stuart LA, et al. Chlamydia trachomatis infection in mothers and infant: a prospective study. Am J Dis Child 1981; 135:507–11PubMedGoogle Scholar
  18. 18.
    Schlachter J, Grossman M, Sweet RL, et al. Prospective study of perinatal transmission of Chlamydia trachomatis. JAMA 1986; 255: 3374–7CrossRefGoogle Scholar
  19. 19.
    Alexander ER, Harrison HR. Role of Chlamydia trachomatis in perinatal infection. Rev Infant Dis 1983; 5: 713–9CrossRefGoogle Scholar
  20. 20.
    Center for Disease Control and Prevention. 1998 guidelines for treatment of sexually transmitted diseases. MMWR Morb Mortal Wkly Rep 1998; 47: 53–6Google Scholar
  21. 21.
    Jones RB. New treatments for Chlamydia trachomatis. Am J Obstet Gynecol 1991; 164: 1789–93PubMedGoogle Scholar
  22. 22.
    Crombleholme WR, Schlachter J, Grossman M, et al. Amoxicillin therapy for Chlamydia trachomatis in pregnancy. Obstet Gynecol 1990; 75: 752–6PubMedGoogle Scholar
  23. 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: 1461–5PubMedCrossRefGoogle Scholar
  24. 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: 745–9PubMedGoogle Scholar
  25. 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: 205–9CrossRefGoogle Scholar
  26. 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: 829–32PubMedGoogle Scholar
  27. 27.
    Alger LS, Lovchik JC. Comparative efficacy of clindamycin versus erythromycin in eradication of antenatal Chlamydia trachomutis. Am J Obstet Gynecol 1991; 165: 375–81PubMedGoogle Scholar
  28. 28.
    Adair CD, Gunter M, Stoval TG, et al. Chlamydia in pregnancy: a randomized trial of azithromycin and erythromycin. Obstet Gynecol 1998; 91: 165–8PubMedCrossRefGoogle Scholar
  29. 29.
    Bush MR, Rosa C. Azithromycin and erythromycin in the treatment of cervical chlamydial infection during pregnancy. Obstet Gynecol 1994; 84: 61–3PubMedGoogle Scholar
  30. 30.
    Wehbeh HA, Ruggeirio RM, Shahem S, et al. Single-dose azithromycin for Chlamydia in pregnant women. J Reprod Med 1998; 43(6): 509–14PubMedGoogle Scholar
  31. 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: 410CrossRefGoogle Scholar
  32. 32.
    Turrentine MA, Newton ER. Amoxicillin or erythromycin for the treatment of antenatal chlamydial infection: a metaanalysis. Obstet Gynecol 1995; 86: 1021–5PubMedCrossRefGoogle Scholar
  33. 33.
    Miller Jr JM. Efficacy and tolerance of single-dose azithromycin for treatment of chlamydial cervicitis during pregnancy. Infect Dis Obstet Gynecol 1995; 3: 189–92PubMedCrossRefGoogle Scholar
  34. 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: 596–611Google Scholar
  35. 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), 256Google Scholar
  36. 36.
    Katz BP, Zwickl BW, Caine MA, et al. Compliance with antibiotic therapy for Chlamydia trachomatis and Neisseria gonorrhoeae. Sex Transm Dis 1992; 19: 351–4PubMedCrossRefGoogle Scholar
  37. 37.
    Brookhoff D. Compliance with doxycycline therapy for outpatient treatment of pelvic inflammatory disease. South Med J 1994; 87: 1088–91CrossRefGoogle Scholar
  38. 38.
    Genc M, Mordh P-A. Cost-effective treatment of uncompleted gonorrhea including co-infection with Chlamydia trachomatis. Pharmacoeconomics 1997; 12: 374–83PubMedCrossRefGoogle Scholar
  39. 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: 419Google Scholar
  40. 40.
    Miller Jr JM. Recurrent chlamydial colonization during pregnancy. Am J Perinatol 1998; 15: 307–9PubMedCrossRefGoogle Scholar
  41. 41.
    Allaire AD, Huddleston JF, Graves WL, et al. Initial and repeat screening for Chlamydia trachomutis during pregnancy. Infect Dis Obstet Gynecol 1998; 6: 116–22PubMedGoogle Scholar
  42. 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: 253–62PubMedCrossRefGoogle Scholar
  43. 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; 24:287–92PubMedCrossRefGoogle Scholar
  44. 44.
    Ramstedt K, Forssman L, Johannisson G. Contact tracing in the control of genital Chlamydia trachomatis infection. Int J STD AIDS 1991; 2: 116–8PubMedGoogle Scholar
  45. 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: 10–17Google Scholar
  46. 46.
    Hueston WJ, Lenhart JG. A decision analysis to guide antibiotic selection for Chlamydia infection during pregnancy. Arch Fam Med 1997; 6: 551–5PubMedCrossRefGoogle Scholar
  47. 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: 7–16PubMedGoogle Scholar
  48. 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: 359–99Google Scholar
  49. 49.
    Haddix AC, Hillis SD, Kassler WJ. The cost effectiveness of azithromycin for Chlamydia trachomatis infection in women. Sex Transm Dis 1995; 22: 274–80PubMedCrossRefGoogle Scholar
  50. 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: 202–8PubMedGoogle Scholar
  51. 51.
    Harrison HR, Alexander ER, Weinstein L, et al. Cervical Chlamydia trachomutis and mycoplasmal infections in pregnancy: epidemiology and outcomes. JAMA 1983; 250: 1721–7PubMedCrossRefGoogle Scholar
  52. 52.
    Sweet RL, Landers DV, Walker C, et al. Chlamydia trachomatis infection and pregnancy outcome. Am J Obstet Gynecol 1987; 156: 824–33PubMedGoogle Scholar
  53. 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): 404–7PubMedGoogle Scholar
  54. 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: 81–7PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • Joseph M. Miller
    • 1
  • David H. Martin
    • 2
  1. 1.Department of Obstetrics and GynecologyLouisiana State University Medical CenterNew OrleansUSA
  2. 2.Department of MedicineLouisiana State University Medical CenterNew OrleansUSA

Personalised recommendations