Antibiotics for gonorrhoea in pregnancy

Pregnant women with gonorrhoea who take penicillin, spectinomycin or ceftriaxone are much less likely to show signs of infection.

Neisseria gonorrhoeae is a bacteria transmitted (passed) during sex, causing an infection in the genital area. Pregnant women with gonorrhoea may pass the infection to babies during birth. This can affect the baby's eyesight, causing blindness. The review of two trials, involving 346 women, found evidence that pregnant women who take penicillin, spectinomycin, ceftriaxone or cefixime are much less likely to have signs of gonorrhoea a week to 10 days later. Further research is needed to find out which antibiotic treatment is the best for preventing infection of the baby.

Authors' conclusions: 

The number of women included in each of the comparisons is small and therefore, although no differences were detected between the different antibiotic regimens, the trials were limited in their ability to detect important but modest differences. For women who are allergic to penicillin, this review provides some reassurance that treatment with ceftriaxone or spectinomycin appears to have similar effectiveness in producing microbiological cure.

[Note: the one citation in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

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Background: 

Neisseria gonorrhoeae can be transmitted from the mother's genital tract to the newborn during birth and can cause gonococcal ophthalmia neonatorum as well as systemic neonatal infection. It can also cause endometritis and pelvic sepsis in the mother.

Objectives: 

The objective of this review was to assess the effects of antibiotic regimens in the treatment of genital infection with gonorrhoea during pregnancy with respect to neonatal and maternal morbidity.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2009) and added the results to the awaiting classification section of the review. We updated this search on 3 January 2012; no new trials identified.

Selection criteria: 

Randomized trials of one regimen of antibiotic versus another in pregnant women with culture confirmed genital gonococcal infection.

Data collection and analysis: 

Eligibility and trial quality were assessed by one review author.

Main results: 

Two trials involving 346 women were included. The only outcome included in these trials was the incidence of 'cure' assessed by bacterial culture. Failure to achieve 'microbiological cure' was similar for each antibiotic regimen: amoxicillin plus probenecid compared with spectinomycin (Peto odds ratio (Peto OR) 2.29, 95% confidence interval (CI) 0.74 to 7.08), amoxicillin plus probenecid compared with ceftriaxone (Peto OR 2.29, 95% CI 0.74 to 7.08) and ceftriaxone compared with cefixime (Peto OR 1.22, 95% CI 0.16 to 9.01). Side-effects were uncommon for all the tested regimens.

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