Alary M, Joly J R, Moutquin J M, Mondor M, Boucher M, Fortier A, Pinault J J, Paris G, Carrier S, Chamberland H
Groupe de Recherche en Epidémiologie, Faculté de Médecine, Université Laval, Québec, Canada.
Lancet. 1994 Nov 26;344(8935):1461-5. doi: 10.1016/s0140-6736(94)90288-7.
Erythromycin, the standard treatment for chlamydial infection in pregnant women, commonly causes side-effects, which limits its efficacy. In a randomised, double-blind study, we compared amoxycillin with erythromycin in this setting. 210 pregnant women with Chlamydia trachomatis infection were randomly assigned 7 days' treatment with amoxycillin (500 mg three times daily) or erythromycin (500 mg four times daily). Control cultures were obtained 21 days after treatment, during late pregnancy, and from the infant within a week of birth. Treatment was judged a failure if any post-treatment culture was positive or if the patient had to stop therapy because of severe side-effects. 11 women (5.2%) were lost to follow-up. 1 (of 100) amoxycillin-treated women had to stop treatment because of severe side-effects compared with 12 (of 99) erythromycin-treated women (p = 0.002). 1 woman in the amoxycillin group had a positive culture at the third-trimester examination. No positive post-treatment culture was found in the erythromycin group. Severe gastrointestinal side-effects were more common in women who received erythromycin (31 vs 6%, p < 0.001). The overall failure rate was therefore 2% in the amoxycillin group and 12% in the erythromycin group (p = 0.005). These results suggest that amoxycillin is an acceptable alternative to erythromycin for C trachomatis infection in pregnant women.
红霉素是孕妇衣原体感染的标准治疗药物，但常引起副作用，这限制了其疗效。在一项随机双盲研究中，我们在此种情况下比较了阿莫西林与红霉素的疗效。210名感染沙眼衣原体的孕妇被随机分配接受7天的阿莫西林（每日三次，每次500毫克）或红霉素（每日四次，每次500毫克）治疗。在治疗后21天、妊娠晚期以及婴儿出生后一周内采集对照培养样本。如果任何治疗后的培养样本呈阳性，或者患者因严重副作用而不得不停止治疗，则判定治疗失败。11名女性（5.2%）失访。100名接受阿莫西林治疗的女性中有1名因严重副作用而不得不停止治疗，相比之下，99名接受红霉素治疗的女性中有12名（p = 0.002）。阿莫西林组有1名女性在孕晚期检查时培养样本呈阳性。红霉素组未发现治疗后培养样本呈阳性的情况。接受红霉素治疗的女性中严重胃肠道副作用更为常见（31% 对6%，p < 0.001）。因此，阿莫西林组的总体失败率为2%，红霉素组为12%（p = 0.005）。这些结果表明，对于孕妇沙眼衣原体感染，阿莫西林是红霉素的可接受替代药物。
