TREATMENT EVALUATION OF GENITAL CHLAMYDIA TRACHOMATIS INFECTION DURING PREGNANCY
Main Article Content
Keywords
Chlamydia trachomatis, Pregnant women, Clindamycin, Erythromycin, Azithromycin, Amoxicillin, Sexually transmitted infections, Infertility
Abstract
Background: Chlamydia trachomatis is an intracellular pathogenic bacterium whose solitary natural host is human. Ct is a sexually transmitted disease normally detected during pregnancy and thus has been associated with adverse pregnancy outcomes and also mother-to-child transmission can occur at the time of birth and may result in premature rupture of membranes, preterm birth, low birth weight, conjunctivitis, and pneumonia in infants if left untreated.
Aims and Objectives: The main objective of this review is to evaluate existing literature to determine potential benefits of antenatal treatment evaluation for treating genital chlamydia trachomatis infection during pregnancy to prevent adverse outcomes that leads to either neonatal or mother morbidity. The literature will also analyze the most efficacious antibiotic regimen to treat Chlamydia trachomatis infections in pregnancy, side effects of the treatment regimen and resistance.
Methodology: I have searched data from PubMed, Cochrane Library and Scopus till the end of February 2024. Only Randomized control trials that meet the inclusion criteria of antibiotics consider safe to consume during pregnancy for genital chlamydia trachomatis are Macrolides (Azithromycin, Erythromycin), Clindamycin and Amoxicillin compared with either placebo or no treatment or any alternative antibiotic treatment were included.
Results: Clindamycin proved somewhat the most successful treatment in eradicating Chlamydia trachomatis among pregnant women (95%) which significantly related to least treatment failure (5.2%) as compared to azithromycin, erythromycin and Amoxicillin. Among all of the Comparisons of Erythromycin with other antibiotic treatment like Amoxicillin, Clindamycin, Azithromycin the rate of GIT side effects associated to Erythromycin are significantly higher than others (27%).
Conclusion: In conclusion, the best antibiotic for treating C. trachomatis infections during pregnancy is Clindamycin. Clindamycin's characteristic pharmacokinetic profile enabled a high degree of patient compliance and a high success rate in eliminating the active infection with less gastrointestinal side effects.
References
2. Alary, M., Joly, J.R., Moutquin, J.M., Mondor, M., Boucher, M., Fortier, A., Pinault, J.J., Paris, G., Carrier, S. and Chamberland, H. (1994). Randomised comparison of amoxycillin and erythromycin in treatment of genital chlamydial infection in pregnancy. Lancet (London, England), [online] 344(8935), pp.1461–1465. doi:https://doi.org/10.1016/s0140-6736(94)90288-7.
3. Alger, L.S. and Lovchik, J.C. (1991). Comparative efficacy of clindamycin versus erythromycin in eradication of antenatal Chlamydia trachomatis. American Journal of Obstetrics and Gynecology, [online] 165(2), pp.375–381. doi:https://doi.org/10.1016/0002-9378(91)90097-b.
4. Bush, M.R. and Rosa, C. (1994). Azithromycin and erythromycin in the treatment of cervical chlamydial infection during pregnancy. Obstetrics and Gynecology, [online] 84(1), pp.61–63. Available at: https://pubmed.ncbi.nlm.nih.gov/8008325/ [Accessed 11 Mar. 2024].
5. Edwards, M.S., Newman, R.B., Carter, S.G., Leboeuf, F.W., Menard, M.K. and Rainwater, K.P. (1996). Randomized Clinical Trial of Azithromycin vs. Erythromycin for the Treatment of Chlamydia Cervicitis in Pregnancy. Infectious Diseases in Obstetrics and Gynecology, [online] 4(6), pp.333–337. doi:https://doi.org/10.1155/S1064744996000671.
6. Jacobson, G.F., Autry, A.M., Kirby, R.S., Liverman, E.M. and Motley, R.U. (2001). A randomized controlled trial comparing amoxicillin and azithromycin for the treatment of Chlamydia trachomatis in pregnancy. American Journal of Obstetrics and Gynecology, 184(7), pp.1352–1356. doi:https://doi.org/10.1067/mob.2001.115050.
7. Kacmar, J., Cheh, E., Montagno, A. and Peipert, J.F. (2001). A Randomized Trial of Azithromycin Versus Amoxicillin for the Treatment of Chlamydia trachomatis in pregnancy. Infectious Diseases in Obstetrics and Gynecology, 9(4), pp.197–202. doi:https://doi.org/10.1155/s1064744901000321.
8. Magat, A.H., Alger, L.S., Nagey, D.A., Hatch, V. and Lovchik, J.C. (1993). Double-blind randomized study comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy. Obstetrics and Gynecology, [online] 81(5 ( Pt 1)), pp.745–749. Available at: https://pubmed.ncbi.nlm.nih.gov/8469466/ [Accessed 11 Mar. 2024].
9. Martín, D.H., Eschenbach, D.A., Mary Frances Cotch, Nugent, R.P., Rao, A.P., Klebanoff, M.A., Lou, Y., Rettig, P.J., Gibbs, R.S., Pastorek, J.G., Regan, J.A. and Kaslow, R.A. (1997). Double-Blind Placebo-Controlled Treatment Trial ofChlamydia trachomatisEndocervical Infections in Pregnant Women. Infectious diseases in obstetrics and gynecology, 5(1), pp.10–17. doi:https://doi.org/10.1155/s1064744997000057.
10. Okunola, T.O., Ajenifuja, K.O., Ogunniyi, S.O. and Aboderin, A.O. (2016). Erythromycin versus amoxicillin for the management of chlamydia infection in pregnant women: a randomized controlled trial. International Journal of Medicine and Biomedical Research, [online] 5(1), pp.35–42. doi:https://doi.org/10.14194/ijmbr.5.1.5.
11. Rosenn, M.F., Macones, G.A. and Silverman, N.S. (1995). Randomized trial of erythromycin and azithromycin for treatment of chlamydial infection in pregnancy. Infectious Diseases in Obstetrics and Gynecology, [online] 3(6), pp.241–244. doi:https://doi.org/10.1155/S1064744995000718.
12. Silverman, N.S., Sullivan, M., Hochman, M., Womack, M. and Jungkind, D.L. (1994). A randomized, prospective trial comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy. American Journal of Obstetrics and Gynecology, 170(3), pp.829–832. doi:https://doi.org/10.1016/s0002-9378(94)70292-6.
13. Turrentine, M.A., Troyer, L. and Gonik, B. (1995). Randomized prospective study comparing erythromycin, amoxicillin, and clindamycin for the treatment of chlamydia trachomatis in pregnancy. Infectious Diseases in Obstetrics and Gynecology, [online] 2(5), pp.205–209. doi:https://doi.org/10.1155/S1064744995000020.
14. Wehbeh, H.A., Ruggeirio, R.M., Shahem, S., Lopez, G. and Ali, Y. (1998). Single-dose azithromycin for Chlamydia in pregnant women. The Journal of reproductive medicine, [online] 43(6), pp.509–514. Available at: https://europepmc.org/article/med/9653697 [Accessed 11 Mar. 2024].
15. Bell, T., Sandstrom, I., Eschenbach, D., Hummel, D., Kuo, C., Wang, S., et al. (1982). Treatment of Chlamydia trachomatis in pregnancy with amoxicillin. Fernstrom Foundation Series, 2, 221-224.
16. Gunter, M.E., Adair, C.D., Ernest, J.M., & McElroy, G. (1996). Azithromycin powder versus erythromycin in the treatment of chlamydial cervicitis in pregnancy. Infectious Diseases in Obstetrics and Gynecology, 4, 53.
17. Gilbert, E. (1992). Comparative efficacy of Clindamycin versus Erythromycin in eradication of antenatal Chlamydia trachomatis. Annals of Emergency Medicine, 21(1), 105.
18. Daskalakis, G., Alexandros Psarris, Koutras, A., Zacharias Fasoulakis, Ioannis Prokopakis, Varthaliti, A., Karasmani, C., Ntounis, T., Ekaterini Domali, Theodora, M., Panos Antsaklis, Pappa, K.I. and Angeliki Papapanagiotou (2023). Maternal Infection and Preterm Birth: From Molecular Basis to Clinical Implications. Children, 10(5), pp.907–907. doi:https://doi.org/10.3390/children10050907.
19. Dian, T. (2022). March 2022 - Volume 75 - Issue : Annals of Medicine and Surgery. [online] journals.lww.com. Available at: https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2022/03000/female_urogenital_chlamydia__epidemiology [Accessed 9 Oct. 2023].
20. Emily R. BA, G. (2020). April 2020 - Volume 135 - Issue 4 : Obstetrics & Gynecology. [online] journals.lww.com. Available at: https://journals.lww.com/greenjournal/Abstract/2020/04000/Patterns_of_Screening.
21. Ghasemian, E., Harding-Esch, E., Mabey, D. and Holland, M.J. (2023). When Bacteria and Viruses Collide: A Tale of Chlamydia trachomatis and Sexually Transmitted Viruses. Viruses, [online] 15(9), p.1954. doi:https://doi.org/10.3390/v15091954.
22. Land, J.A., Van Bergen, J.E.A.M., Morre, S.A. and Postma, M.J. (2009). Epidemiology of Chlamydia trachomatis infection in women and the cost-effectiveness of screening. Human Reproduction Update, [online] 16(2), pp.189–204. doi:https://doi.org/10.1093/humupd/dmp035.
23. Moore, R.K., Mallett, P., Hull, S., Christie, S., Simpson, E., Bowen, J., Dinsmore, W.W., McCaughey, C. and Livingstone, A. (2022). Chlamydia trachomatisconjunctivitis in the pre-pubertal child. Archives of Disease in Childhood-education and Practice Edition, 108(2), pp.104–108. doi:https://doi.org/10.1136/archdischild-2022-323845.
24. Mussa, A., Wynn, A., Ryan, R., Babalola, C.M., Hansman, E., Simon, S., Bame, B., Tamuthiba, L., Ramontshonyana, K., Ndlovu, N., Moshashane, N., Masole, M., Klausner, J.D. and Morroni, C. (2023). Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infection and associated factors among asymptomatic pregnant women in Botswana. International journal of STD & AIDS, [online] 34(7), pp.448–456. doi:https://doi.org/10.1177/09564624231163203.
25. Niu, S., Huang, S. and Liu, B. (2024). Chapter 65 - Chlamydia trachomatis. [online] ScienceDirect. Available at: https://www.sciencedirect.com/science/article/abs/pii/B9780128186190000496 [Accessed 11 Mar. 2024].
26. Omer, H.M.H., Khalid, K.E., Miskeen, E.I., Taha, M.Y., Saleh, E.Y., Ahmed, E.A., Abdelwahid, O.H., Hassan, M.A. and Abakar, A.D. (2023). Cytological and molecular screening of Chlamydia trachomatis in infertile women attending a maternity teaching hospital in Gezira State, Sudan: a cross-sectional study. [online] f1000research.com. Available at: https://f1000research.com/articles/9-589 [Accessed 11 Mar. 2024].
27. Ramnarain, C., Govender, R., N Mabaso and N Abbai (2023). The impact of Chlamydia trachomatis infection on pregnancy and neonatal outcomes. The journal of medical laboratory science & technology of South Africa, 5(1), pp.39–45. doi:https://doi.org/10.36303/jmlstsa.135.
28. Rodrigues, R., Marques, L., Vieira-Baptista, P., Sousa, C. and Vale, N. (2022). Therapeutic Options for Chlamydia trachomatis Infection: Present and Future. Antibiotics, 11(11), p.1634. doi:https://doi.org/10.3390/antibiotics11111634.
29. Rodrigues, R., Sousa, C. and Vale, N. (2022). Chlamydia trachomatis as a Current Health Problem: Challenges and Opportunities. Diagnostics, 12(8), p.1795. doi:https://doi.org/10.3390/diagnostics12081795.
30. Usta, S.S. (2023). Chlamydia trachomatis Infection in Women. [online] www.intechopen.com. Available at: https://www.intechopen.com/chapters/87139 [Accessed 11 Mar. 2024].
31. Wang, J., Zhao, P., Xu, W. and Wang, C. (2023). Changing trends in Chlamydia and gonorrhea infections among female sex workers in Southern China: a surveillance data analysis spanning 2019 to 2022. Journal of Public Health, [online] 46(1). doi:https://doi.org/10.1093/pubmed/fdad222.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Shahana Wahid
Assistant Professor, Department of Pharmacy, Benazir Bhutto Shaheed University Lyari, Karachi, Pakistan
Nausheen Hameed Siddiqui
Assistant Professor, Department of Pharmacy, Benazir Bhutto Shaheed University Lyari, Karachi, Pakistan
Kamran Zaheer
Professor, Department of Pharmaceutics, Hamdard University, Karachi, Pakistan
Farah Owais
Assistant Professor, Federal Urdu University, Karachi, Pakistan
Khaola Tahreem Qaiser
MBBS, Jinnah Medical and Dental College, Karachi, Pakistan
Rida Islam
MPhil Fellow, Jinnah University for Women, Karachi, Pakistan
Javeria Javed
PhD fellow, Department of Pharmacology, Jinnah University for Women, Karachi, Pakistan
Wajeeha Ishrat
Lecturer, Department of Pharmacology, Federal Urdu University, Karachi, Pakistan