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Evidence summaries

Interventions for Treating Genital Chlamydia Trachomatis Infection in Pregnancy

Erythromycin, azithromycin, clindamycin and amoxicillin are effective for genital chlamydial infections in pregnancy. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 15 trials involving a total of 1754 pregnant women. Erythromycin and clindamycin were associated with improved microbiological cure compared to placebo T1. There were no trials comparing azithromycin to placebo. However, azithromycin was at least as effective as erythromycin T2. Azithromycin and clindamycin appear to result in fewer side effects than erythromycin.

Erythromycin / clindamycin / amoxycillin compared to placebo for treating genital Chlamydia trachomatis infection in pregnancy

Outcome: Microbiological cureRelative effect(95% CI)Risk with control -PlaceboRisk with intervention -Antibiotics (95% CI)№of participants(studies)
ErythromycinRR 2.64(1.60 to 4.38)344 per 1000908 per 1000(550 to 1000)495(2)
ClindamycinRR 4.08(2.35 to 7.08)227 per 1000927 per 1000(534 to 1000)85(1)
AmoxicillinRR 2.00(0.59 to 6.79)333 per 1000667 per 1000(197 to 1000)15(1)

Azithromycin / clindamycin / amoxicillin compared to erythromycin for treating genital Chlamydia trachomatis in pregnancy

Outcome: Microbiological cureRelative effect(95% CI)Risk with control - ErythromycinRisk with intervention -another antibiotics (95% CI)№of participants(studies)
AzithromycinRR 1.11(1.00 to 1.23) RCTs)825 per 1000916 per 1000(825 to 1000)374(6)
ClindamycinRR 1.06(0.97 to 1.15)905 per 1000959 per 1000(878 to 1000)173(2)
AmoxicillinRR 0.97(0.93 to 1.01)954 per 1000925 per 1000(887 to 963)466(4)

Comment: The quality of evidence is downgraded by study limitations and upgraded by large magnitude of effect.

    References

    • Cluver C, Novikova N, Eriksson DO et al. Interventions for treating genital Chlamydia trachomatis infection in pregnancy. Cochrane Database Syst Rev 2017;(9):CD010485. [PubMed]

Primary/Secondary Keywords