A Cochrane review «Interventions for treating genital Chlamydia trachomatis infection in pregnancy»1 «Cluver C, Novikova N, Eriksson DO et al. Interventions for treating genital Chlamydia trachomatis infection in pregnancy. Cochrane Database Syst Rev 2017;(9):CD010485. »1 included 15 trials involving a total of 1754 pregnant women. Erythromycin and clindamycin were associated with improved microbiological cure compared to placebo «Erythromycin / clindamycin / amoxycillin compared to placebo for treating genital Chlamydia trachomatis infection in pregnancy»1. There were no trials comparing azithromycin to placebo. However, azithromycin was at least as effective as erythromycin «Azithromycin / clindamycin / amoxicillin compared to erythromycin for treating genital Chlamydia trachomatis in pregnancy»2. Azithromycin and clindamycin appear to result in fewer side effects than erythromycin.
| Outcome: Microbiological cure | Relative effect (95% CI) | Risk with control -Placebo | Risk with intervention -Antibiotics (95% CI) | № of participants (studies) |
|---|---|---|---|---|
| Erythromycin | RR 2.64 (1.60 to 4.38) | 344 per 1000 | 908 per 1000 (550 to 1000) | 495 (2) |
| Clindamycin | RR 4.08 (2.35 to 7.08) | 227 per 1000 | 927 per 1000 (534 to 1000) | 85 (1) |
| Amoxicillin | RR 2.00 (0.59 to 6.79) | 333 per 1000 | 667 per 1000 (197 to 1000) | 15 (1) |
| Outcome: Microbiological cure | Relative effect (95% CI) | Risk with control - Erythromycin | Risk with intervention -another antibiotics (95% CI) | № of participants (studies) |
|---|---|---|---|---|
| Azithromycin | RR 1.11 (1.00 to 1.23) RCTs) | 825 per 1000 | 916 per 1000 (825 to 1000) | 374 (6) |
| Clindamycin | RR 1.06 (0.97 to 1.15) | 905 per 1000 | 959 per 1000 (878 to 1000) | 173 (2) |
| Amoxicillin | RR 0.97 (0.93 to 1.01) | 954 per 1000 | 925 per 1000 (887 to 963) | 466 (4) |
Comment: The quality of evidence is downgraded by study limitations and upgraded by large magnitude of effect.