Efficacy of treatment regimens for lower urogenital Chlamydia trachomatis infection in women

Bowie, William; Manzon, L.M.; Borrie-Hume, C.J.; Fawcett, A.; Jones, Hugh D.

doi:10.1016/s0002-9378(16)32325-0

Cited by 41 publications

(4 citation statements)

References 5 publications

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“…It has furthermore been found (6) that women with a positive Chlamydia culture had had gonorrhea significantly more often than Chlamydia-negative women. In contrast to metronidazole, pivampicillin given for 4 days might have an effect on Chlamydia (9).…”

Section: Resultsmentioning

confidence: 97%

Prophylactic Antibiotics in Women with a History of Pelvic Inflammatory Disease Undergoing First‐Trimester Abortion

Heisterberg

1987

Acta Obstet Gynecol Scand

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In a double-blind controlled trial the effect of prophylactic metronidazole on postabortal infection in women with a history of pelvic inflammatory disease (PID) was assessed. One hundred and thirty-five women were eligible for randomization, of whom 17 were excluded. The regimen consisted of oral metronidazole 400 mg 1 h before the abortion and again 4 and 8 h after, or else placebo. In the placebo group the rate of postabortal PID was 13.0% (7/54) and in the metronidazole group 10.9% (7/64), a nonsignificant difference (p greater than 0.7). Women in gestational weeks 11-12 had a significantly increased rate of postabortal PID compared with women in weeks 6-10 (p less than 0.005), but this rate was not influenced by the treatment (p greater than 0.2). Women with parity 1 had a significantly increased rate of postabortal PID compared with women with parity 0 (p less than 0.05), but again the treatment did not influence this rate significantly (p greater than 0.2). The number of hospital days for women in the metronidazole group did not differ significantly from that in the placebo group (p less than 0.1). The amount of metronidazole administered for prophylactic and postabortal treatment was significantly greater in the metronidazole group (p less than 0.001). The amounts of other antibiotics prescribed showed non-significant differences between the two groups (all p-values greater than 0.3).

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Section: Resultsmentioning

confidence: 97%

Prophylactic Antibiotics in Women with a History of Pelvic Inflammatory Disease Undergoing First‐Trimester Abortion

Heisterberg

1987

Acta Obstet Gynecol Scand

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“…8,21,22 Sulfadoxine belongs to a group of agents (sulfonamides) that have been previously used to treat Trichomonas vaginalis, 23 Gardnerella vaginalis (a bacterium associated with bacterial vaginosis), 24 Neisseria gonorrhoeae, 25 and Chlamydia trachomatis. 26 These infections are prevalent among pregnant women in east Africa (range 3•7-50•8%). 27 Although sulfadoxinepyrimethamine is unlikely to cure these infections, antenatal dosing has been shown to reduce adverse pregnancy outcomes among women who had these non-malarial infections at antenatal booking.…”

Section: Discussionmentioning

confidence: 99%

Overall, anti-malarial, and non-malarial effect of intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine on birthweight: a mediation analysis

Roh

Kuile

Rerolle

et al. 2020

The Lancet Global Health

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Background Trials of intermittent preventive treatment (IPTp) of malaria in pregnant women that compared dihydroartemisinin-piperaquine with the standard of care, sulfadoxine-pyrimethamine, showed dihydroartemisininpiperaquine was superior at preventing malaria infection, but not at improving birthweight. We aimed to assess whether sulfadoxine-pyrimethamine shows greater non-malarial benefits for birth outcomes than does dihydroartemisinin-piperaquine, and whether dihydroartemisinin-piperaquine shows greater antimalarial benefits for birth outcomes than does sulfadoxine-pyrimethamine. MethodsWe defined treatment as random assignment to sulfadoxine-pyrimethamine or dihydroartemisininpiperaquine before pooling individual participant-level data from 1617 HIV-uninfected pregnant women in Kenya (one trial; n=806) and Uganda (two trials; n=811). We quantified the relative effect of treatment on birthweight (primary outcome) attributed to preventing placental malaria infection (mediator). We estimated antimalarial (indirect) and non-malarial (direct) effects of IPTp on birth outcomes using causal mediation analyses, accounting for confounders. We used two-stage individual participant data meta-analyses to calculate pooled-effect sizes. Findings Overall, birthweight was higher among neonates of women randomly assigned to sulfadoxine-pyrimethamine compared with women assigned to dihydroartemisinin-piperaquine (mean difference 69 g, 95% CI 26 to 112), despite placental malaria infection being lower in the dihydroartemisinin-piperaquine group (relative risk [RR] 0•64, 95% CI 0•39 to 1•04). Mediation analyses showed sulfadoxine-pyrimethamine conferred a greater non-malarial effect than did dihydroartemisinin-piperaquine (mean difference 87 g, 95% CI 43 to 131), whereas dihydroartemisininpiperaquine conferred a slightly larger antimalarial effect than did sulfadoxine-pyrimethamine (8 g, -9 to 26), although more frequent dosing increased the antimalarial effect (31 g, 3 to 60). Interpretation IPTp with sulfadoxine-pyrimethamine appears to have potent non-malarial effects on birthweight.Further research is needed to evaluate monthly dihydroartemisinin-piperaquine with sulfadoxine-pyrimethamine (or another compound with non-malarial effects) to achieve greater protection against malarial and non-malarial causes of low birthweight.

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“…This probably accounts for the large discrepancies in published reports of MICs of penicillins (4,6,9,10,(13)(14)(15)(16). In vivo, single-dose penicillin treatment does not usually eradicate C. trachomatis (7,10), but multiple-dose penicillin treatment often results in negative follow-up cultures for weeks or longer (2,5,7,12). Because of this activity, penicillins have been considered for use in the treatment of uncomplicated chlamydial infections in pregnancy (2).…”

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confidence: 99%

In vitro activity of clavulanic acid, amoxicillin, and ticarcillin against Chlamydia trachomatis

Bowie¹

1986

Antimicrob Agents Chemother

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In vitro, growth of Chlamydia trachomatis was not entirely eliminated by 960 ,ig of ticarcillin per ml, 64 ,ug of amoxicillin per ml, 32 ,ug of clavulanic acid per ml, a combination of ticarcillin (480 ,ig/ml) and clavulanic acid (32 ,ig/ml), and a combination of amoxicillin (32 ,ig/ml) and clavulanic acid (8 ,ig/ml). However, a -99% decrease in the number of inclusions was obtained at concentrations readily attainable in serum.Penicillins have partial activity against Chlamydia trachomatis both in vitro and in vivo (2-7, 9, 16). For most antimicrobial agents, MICs are well defined and the number of inclusions in cell cultures declines dramatically from numbers near those in controls without antimicrobial agents to nil over only a few dilutions (6,10,14,15). In contrast, with penicillins there are occasional inclusions over a wide range of concentrations (6,10,14,15). This probably accounts for the large discrepancies in published reports of MICs of penicillins (4,6,9,10,(13)(14)(15)(16). In vivo, single-dose penicillin treatment does not usually eradicate C. trachomatis (7, 10), but multiple-dose penicillin treatment often results in negative follow-up cultures for weeks or longer (2,5,7,12). Because of this activity, penicillins have been considered for use in the treatment of uncomplicated chlamydial infections in pregnancy (2). Clavulanic acid, in combination with amoxicillin or ticarcillin, has been used in the treatment of genital syndromes or infections such as the frequencydysuria syndrome and pelvic inflammatory disease (1,8) that are sometimes caused by C. trachomatis (11,17). Consequently, it is important to know whether the addition of clavulanic acid to amoxicillin or ticarcillin enhances in vitro activity against C. trachomatis. In this study, the activities of amroxicillin, ticarcillin, and clavulanic acid alone, clavulanic acid in combination with amoxicillin, and clavulanic acid in combination with ticarcillin were evaluated in vitro against C. trachomatis in cell cultures.Twenty-one strains of C. trachomatis were used, including three typed strains (B, DE, and FG) initially isolated from men with nongonococcal urethritis in Seattle, Wash., one LGV2 strain kindly provided by Julius Schachter, and 17 genital isolates from men and women in Vancouver or Edmonton, Alberta, Canada. Isolates were passed in cycloheximide-treated McCoy cells and stored at -70°C when not in use. All strains were in passage 7 to 10 at the time of use.Antimicrobial agents were reconstituted and diluted with 0.4 M sucrose phosphate the day of use (6, 15). The final concentrations evaluated for ticarcillin were 960, 480, 30, 7.5, 1.875, and 0.469 ,uggml; for amoxicillin they were 64, 16, 4, 1, and 0.25 ,ug/ml; for clavulanic acid they were 32, 16, 4, 1, and 0.25 ,ug/ml; for the combination of ticarcillin and clavulanic acid in a 15:1 ratio they were 480 and 32, 30 and 2, 7.5 and 0.5, 1.875 and 0.125, and 0.469 and 0.031 p.g/ml;and for the combination of amoxicillin with clavulanic acid in a 4:1 ratio they were 32 and 8, 8 an...

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Efficacy of treatment regimens for lower urogenital Chlamydia trachomatis infection in women

Cited by 41 publications

References 5 publications

Prophylactic Antibiotics in Women with a History of Pelvic Inflammatory Disease Undergoing First‐Trimester Abortion

Prophylactic Antibiotics in Women with a History of Pelvic Inflammatory Disease Undergoing First‐Trimester Abortion

Overall, anti-malarial, and non-malarial effect of intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine on birthweight: a mediation analysis

In vitro activity of clavulanic acid, amoxicillin, and ticarcillin against Chlamydia trachomatis

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