What is the treatment for chlamydia (Chlamydia trachomatis) in a pregnant patient?

From the Guidelines

For pregnant patients with chlamydia, the recommended treatment is azithromycin 1 gram orally as a single dose, as outlined in the most recent guidelines 1. This is the first-line therapy due to its safety profile during pregnancy and high efficacy against Chlamydia trachomatis. Some key points to consider in the treatment of chlamydia in pregnant patients include:

• Alternative options include amoxicillin 500 mg orally three times daily for 7 days if azithromycin cannot be used, as indicated by the CDC guidelines 1.
• Doxycycline, which is commonly used in non-pregnant patients, is contraindicated during pregnancy due to potential adverse effects on fetal development.
• Treatment is essential as untreated chlamydia during pregnancy can lead to preterm labor, premature rupture of membranes, low birth weight, and transmission to the newborn during delivery, potentially causing conjunctivitis or pneumonia.
• 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.
• A test of cure is recommended 3-4 weeks after treatment completion to ensure the infection has been eradicated, as this is particularly important during pregnancy to prevent complications. It's worth noting that the US Preventive Services Task Force recommends screening for chlamydial infection in all sexually active women 24 years of age or younger, including adolescents, and in older women at increased risk 1. However, the primary concern in this context is the effective treatment of chlamydia in pregnant patients to prevent adverse outcomes, and azithromycin remains the preferred choice due to its safety and efficacy, as supported by the latest evidence 1.

From the FDA Drug Label

Urogenital Infections During Pregnancy Due to Chlamydia trachomatis Although the optimal dose and duration of therapy have not been established, the suggested treatment is 500 mg of erythromycin by mouth four times a day on an empty stomach for at least 7 days For women who cannot tolerate this regimen, a decreased dose of one erythromycin 500 mg tablet orally every 12 hours or 250 mg by mouth four times a day should be used for at least 14 days.

• The suggested treatment for chlamydia in pregnant patients is 500 mg of erythromycin by mouth four times a day on an empty stomach for at least 7 days.
• If the patient cannot tolerate this regimen, a decreased dose of one erythromycin 500 mg tablet orally every 12 hours or 250 mg by mouth four times a day should be used for at least 14 days 2.

From the Research

Treatment Options for Chlamydia in Pregnant Patients

• Azithromycin is a commonly used treatment for chlamydia in pregnant patients, with a cure rate of 96% as reported in a study published in 1995 3.
• The treatment typically involves a single 1-g oral dose of azithromycin, which has been shown to be effective and well-tolerated in pregnant women 3, 4.
• However, a more recent study published in 2020 found that nearly 1 in 4 pregnancies with repeat testing had persistent or recurrent chlamydia after azithromycin treatment, highlighting the importance of performing a test of cure and ensuring partner therapy 5.

Efficacy and Safety of Azithromycin

• Azithromycin has been shown to be as effective as a standard 7-day twice daily regimen of doxycycline and more effective than 7 days of ciprofloxacin in eradicating uncomplicated chlamydial genital infections 6.
• A study published in 1998 found that azithromycin substantially improved cure rates and reduced the occurrence of severe side effects associated with the use of a standard course of erythromycin in pregnant women 4.
• Another study published in 1994 found that azithromycin had similar cure rates to erythromycin, but with significantly fewer gastrointestinal side effects 7.

Considerations for Treatment

• The choice of treatment should take into account the potential for side effects and the importance of ensuring partner therapy to reduce the risk of recurrent chlamydia 5.
• Azithromycin is generally well-tolerated, but patients should be monitored for potential side effects and treated accordingly 3, 4, 7.