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Treatment of chlamydial infections

Penicillins and cephalosporins

Amoxycillin at 500 mg orally three times a day for 7 to 10 days was recommended by the CDC in 1993 for use in pregnant women with chlamydial infection who are unable to tolerate erythromycin therapy, a common problem [CDC, 1993]. Both drugs were found to be highly effective for eradicating C. trachomatis genital tract infection, but 12 of 99 women treated with erythromycin had to stop therapy because of side effects, whereas this was the case with only 1 of 100 women treated with amoxycillin [Alary et al., 1994]. This has been confirmed by a recent Cochrane collaboration meta-analysis of 11 trials.  Amoxycillin was as effective as erythromycin in achieving microbiological cure (odds ratio 0.54; 95% confidence interval 0.28 to 1.02) and was better tolerated (odds ratio 0.16, 95% confidence interval 0.09 to 0.30). Clindamycin and azithromycin also appeared to be effective, though the numbers of women included in the trials were small. It was concluded that clindamycin or azithromycin might be considered if erythromycin and amoxycillin were contra-indicated or not tolerated [Brocklehurst & Rooney, 2002]. 

Other penicillins and all cephalosporins have no role in the management of chlamydial infection. Any regime for genital tract infection that includes cephalosporin should be supplemented with an antibiotic effective against chlamydiae and, preferably, mycoplasma [Ridgway, 1997]. 

[MEW] May 2002

References

Alary, M., Joly, J. R., Moutquin, J. M., Mondor, M., Boucher, M., Fortier, A., Pinault, J. J., Paris, G., Carrier, S., Chamberland, H., et al., (1994). Randomised comparison of amoxycillin and erythromycin in treatment of genital chlamydial infection in pregnancy. Lancet 344 (8935) 1461 - 1465.

Brocklehurst, P. & Rooney, G. (2002). Interventions for treating genital Chlamydia trachomatis infections in pregnancy. (Cochrane review).

Centers for Disease Control and Prevention (1993). Recommendations for the prevention and management of Chlamydia trachomatis infections. Morbidity and Mortality Weekly Reports 42, (RR-12): 1 - 102.

Ridgway, G. L. (1997). Treatment of chlamydial genital infection. Journal of Antimicrobial Chemotherapy 40, 311 - 314. Full article    [Good review].