Antibiotics for gonorrhoea in pregnancy

Cochrane Review by Brocklehurst P

This record should be cited as: Brocklehurst P. Antibiotics for gonorrhoea in pregnancy. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000098. DOI: 10.1002/14651858.CD000098.

ABSTRACT

Title

Antibiotics for gonorrhoea in pregnancy

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 January 2007).

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.

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.

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