RHL Commentary by Pisake Lumbiganon
EVIDENCE SUMMARY
Four antibiotic regimens, amoxycillin with probenecid, ceftriaxone, spectinomycin and cefixime for the treatment of gonorrhoea in pregnancy were evaluated in the two trials included in this review. All tested antibiotic regimens are very effective in the treatment of gonorrhoea as evaluated by the achievement of a 'microbiological cure'. Amoxycillin with probenecid appears to be less effective than the other three antibiotic regimens but the numbers included in all groups were relatively small to reach any conclusion. No other outcomes such as ophtalmia neonatorum or postpartum infection in mothers were reported.
Erythromycin, a recommended antibiotic for the treatment of Chlamydia trachomatis in pregnancy has significant side-effects (mainly nausea and vomiting). Amoxycillin, azithromycin, clindamycin and erythromycin were evaluated in the eleven trials included in this review. Amoxycillin was surprisingly found to be even more effective than erythromycin in achieving 'microbiological cure', although this result was not statistically significant. Amoxycillin was better tolerated than erythromycin. Both azithromycin and clindamycin appear to be effective and better tolerated than erythromycin but the number of women in these trials was small.
All adequately controlled trials, which could be identified, have been included and appropriately analysed.
The full RHL commentary also includes sections on: Relevance
- Magnitude of the problem
- Feasibility of the intervention
- Applicability of the results of the Cochrane Review
- Implementation of the intervention
- Research
This document should be cited as: Pisake Lumbiganon. The treatment of gonorrhoea and genital Chlamydia trachomatis infection in pregnancy: RHL commentary (last revised: 15 September 2004). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com
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