Miller J M, Martin D H
Department of Obstetrics and Gynecology, Louisiana State University Medical Center, New Orleans 70112, USA.
Drugs. 2000 Sep;60(3):597-605. doi: 10.2165/00003495-200060030-00006.
The intent of this article is to provide an overview of the epidemiology and pharmacotherapy, including cost analyses, of Chlamydia trachomatis infections in pregnant women. Chlamydia is a common sexually transmitted infection. For pregnant women, there are concerns both for the mother (post-partum endometritis, horizontal transmission) and the newborn (conjunctivitis, delayed pneumonia). Therapeutic options are restricted because of the fetus and include multi-day treatment with erythromycin, amoxicillin, clindamycin or single dose azithromycin. Clinical cure rates with these options are 86, 92, 93 and 95%, respectively. Pharmacoeconomic analyses have been conducted to determine if the initial increase in acquisition cost of azithromycin (approximately 3-fold higher than erythromycin or amoxicillin) is offset by improvement in compliance and drug efficacy. Clindamycin has received little attention because of its expense (4-fold more than azithromycin). Analyses have been retrospective. As models incorporate more complications of failure to cure, azithromycin increasingly becomes more cost effective and is our recommended treatment.
本文旨在概述孕妇沙眼衣原体感染的流行病学和药物治疗情况，包括成本分析。衣原体是一种常见的性传播感染。对于孕妇而言，既要关注母亲（产后子宫内膜炎、水平传播），也要关注新生儿（结膜炎、迟发性肺炎）。由于胎儿的原因，治疗选择受到限制，包括用红霉素、阿莫西林、克林霉素进行多日治疗或单剂量阿奇霉素治疗。这些治疗方案的临床治愈率分别为86%、92%、93%和95%。已进行药物经济学分析，以确定阿奇霉素购置成本的最初增加（约为红霉素或阿莫西林的3倍）是否会因依从性和药物疗效的改善而得到抵消。由于克林霉素费用较高（比阿奇霉素贵4倍），因此很少受到关注。分析均为回顾性的。随着模型纳入更多治疗失败的并发症，阿奇霉素越来越具有成本效益，是我们推荐的治疗方法。
