Azithromycin Administration for Maternal Chlamydia Treatment
The most suitable action is azithromycin 1 g orally as a single dose administered to the mother immediately, as this is the first-line treatment for chlamydial infection in pregnancy and represents the most effective strategy to prevent neonatal conjunctivitis and blindness. 1
Why Maternal Treatment is the Priority
Prenatal screening and treatment of pregnant women is the definitive method to prevent chlamydial infection among neonates. 2 The clinical scenario describes a patient at 37 weeks gestation with a history of multiple STDs who has had no prenatal care—this strongly suggests untreated chlamydia, which is the most frequent identifiable infectious cause of ophthalmia neonatorum. 2
Critical Understanding of Prevention vs. Treatment
Neonatal ocular prophylaxis with silver nitrate or antibiotic ointments does NOT prevent perinatal transmission of C. trachomatis from mother to infant. 2 This is a crucial distinction—while these agents prevent gonococcal ophthalmia, they are ineffective against chlamydia. 3
C. trachomatis infection results from perinatal exposure to the mother's infected cervix during delivery. 2 The only way to prevent this transmission is to treat the maternal infection before delivery.
Recommended Treatment Regimen
Azithromycin 1 g orally as a single dose is the first-line treatment for pregnant women with suspected or confirmed chlamydial infection. 1 This recommendation comes from the CDC and represents the most current guideline-based approach.
Alternative Regimens (if azithromycin cannot be used):
- Amoxicillin 500 mg orally three times daily for 7 days 2, 1
- Erythromycin base 500 mg orally four times daily for 7 days 2
Important contraindication: Erythromycin estolate is absolutely contraindicated in pregnancy due to drug-related hepatotoxicity. 2, 1
Why Other Options Are Inadequate
Option A (Reassurance) - Incorrect
- At 37 weeks with no prenatal care and history of multiple STDs, reassurance is inappropriate and dangerous. 1
- The prevalence of C. trachomatis among pregnant women exceeds 5% regardless of demographics. 2
Option C (Newborn Screening After Delivery) - Too Late
- This is reactive rather than preventive—the infant will already have been exposed during delivery. 2
- While screening and treating the neonate is necessary if maternal infection is present, it does not constitute primary prevention. 3
Option D (Referral to Infectious Disease) - Delays Care
- At 37 weeks gestation, delivery is imminent and there is no time for specialty referral. 1
- Treatment is straightforward and should be initiated immediately by the primary provider.
Additional Management Considerations
Test for co-infection with N. gonorrhoeae, as patients with gonorrhea are often co-infected with chlamydia. 1 If gonococcal infection is confirmed, add ceftriaxone 250 mg IM as a single dose. 1
Repeat testing 3 weeks after completion of therapy is recommended for all pregnant women to ensure therapeutic cure. 1
Sexual partner(s) must be evaluated and treated to prevent reinfection. 2, 1
Neonatal Implications if Maternal Treatment is Delayed
If the mother is not treated before delivery, the neonate faces significant risks:
- Conjunctivitis develops 5-12 days after birth in exposed infants. 2
- Chlamydial pneumonia can occur at 1-3 months of age with characteristic staccato cough. 2, 3
- Neonatal treatment requires erythromycin 50 mg/kg/day orally divided into 4 doses for 14 days, which has only 80% efficacy. 2, 3
The answer is B: Azithromycin administration to the mother represents true health promotion and illness prevention by eliminating the source of infection before perinatal transmission can occur.