مقايسه تاثير داروهاي آموكسي سيلين و اريترومايسين بر درمان عفونت كلاميديايي بدون علامت در زنان باردار

A Randomised Cohort Trial Comparing Amoxicillin and Erythromycin Effect on the Treatment of Asymptomatic Chlamydia Trachomatis Infection in Pregnant Women

Introduction & Objective: Chlamydia trachomatis infection is one of the most common sexual infections among childbearing women. Proper treatment of this infection in pregnant women is an important public bealth issue. Our goal was to compare the efficacy of amoxicillin and erythromycin on treatment of asymptomatic acute and chronic chiamydia trachomatis infection in pregnant women. Material & Methods: A randomized cohort trial of pregnant women with chlamydia trachomatis 1gM and IgG positive serum receiving care at two inner city, university - based prenatal clinics were randomly assigned to receive either oral amoxicillin, 500 mg three times daily for 7 days (case grouP 1), erythromycin 400 mg four times for 7 days (case group2) or placebo 500mg three times for 7 days(control group). Participants referred for retesting 4 weeks after initiation of treatment and the patients were followed till delivery.Patients with positive folllow up blood tests were crossed over into the alternate treatment and retested at a later visit. Statitical analysis was performed by using McNemar ,exact f=isher tests and chi square analysis. Results: 333 pregnant women were enrolled in this study and 92 chlamydia infected women (27.62%) completed the protocol. There was no significant difference between delivery gestational age of the groups (39.05, 38.72, 38.6 week) showing that chiamydia infection was not associated with preterm labor. Acute chlamydia infection rates before and after treatment in both amoxicillin and erythromycin groups were significantly different.The rates of acute chlamydia infection reduced from 83.87% before treatment to 35.48% after treatment (p<0.001) in group treated by amoxicillin.This change was 64.51% before treatment vs 29.03 after treatment (p<0,001) in erythromycin group.Chronic chlamydia infection rates in erythromycin group was significantly reduced in compare amoxicillin group after treatment. Based on the results of this study, the rates of chronic chlamydia infection in erythromycin group reduced from 41.93% before treatment to 19.35% after treatment (p=0.01). The change in amoxicillin group was observed before treatment 19.35% vs 12.9% after treatment. In the amoxicillin group , 6 women (19.35%) were intolerant ,compared with 10 women (32.25%) in erythromycin group . Conclusion: Chlamydia infection was not associated with preterm labor. Two kinds of treatments used in this sudy had the similar effects on acute chlamydia infection but erythromycin was more effective than amoxicillin on chronic chlamydia infection .Women treated by amoxicillin had less gastrointestinal complications than those treated by erythromycin .