From the Guidelines
The first-line treatment for chlamydia in pregnant patients is azithromycin 1 gram orally as a single dose. This recommendation is based on the Centers for Disease Control and Prevention (CDC) guidelines, as outlined in the 2006 sexually transmitted disease treatment guidelines 1. Azithromycin is preferred during pregnancy because it has been shown to be safe and effective for both the mother and developing fetus. Some key points to consider when treating chlamydia in pregnant patients include:
- Azithromycin achieves high tissue concentrations and has a long half-life, allowing for convenient single-dose therapy with excellent compliance.
- Alternative treatments include amoxicillin 500 mg orally three times daily for 7 days if azithromycin cannot be used 1.
- Doxycycline, which is commonly used in non-pregnant patients, is contraindicated during pregnancy due to potential adverse effects on fetal development.
- After treatment, a test of cure is recommended 3-4 weeks after completing therapy to ensure the infection has been cleared, as reinfection rates can be high.
- Sexual partners should also be treated to prevent reinfection, and patients should abstain from sexual activity until both they and their partners have completed treatment.
From the FDA Drug Label
Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae.
The first line chlamydia treatment for a pregnant patient is azithromycin. However, the label does not explicitly state that it is safe for pregnant patients, so caution should be exercised. 2
From the Research
First Line Chlamydia Treatment for Pregnant Patients
- The first line treatment for chlamydia in pregnant patients is azithromycin, according to several studies 3, 4, 5, 6.
- Azithromycin has been shown to be effective in treating chlamydia in pregnant women, with a cure rate of 96% in one study 4.
- Amoxicillin is also an option for treating chlamydia in pregnant women, but it has been shown to have similar efficacy to azithromycin in some studies 3, 5.
- A meta-analysis of randomized controlled trials found that azithromycin was associated with similar effectiveness but fewer adverse events compared to erythromycin or amoxicillin in the treatment of pregnant women with chlamydia 6.
- It's worth noting that one study found that azithromycin was probably less effective than doxycycline for microbiological failure in men, but the evidence for women was uncertain 7.
Treatment Options
- Azithromycin: 1 g single dose 4, 5, 6
- Amoxicillin: 500 mg three times daily for 7 days 3, 5
- Erythromycin: not recommended as first line treatment due to higher risk of adverse events 6