A decision analysis to guide antibiotic selection for Chlamydia infection during pregnancy.
OBJECTIVE
To analyze the cost and effectiveness of different antibiotic combinations for the treatment of infection with Chlamydia trachomatis in pregnant women.


METHODS
Using availability treatment effectiveness rates from the literature, a decision analysis model was constructed to determine the effectiveness and cost of therapy with 4 antibiotics shown to be useful for Chlamydia infection during pregnancy. Women who were still infected after initial therapy were then treated with a second antibiotic. Outcomes included the total cost of the treatment (including pretreatment and posttreatment cultures and antibiotic cost) and treatment failure rates.


RESULTS
The lowest failure rates could be achieved with the use of amoxicillin followed by azithromycin for treatment failures or azithromycin followed by clindamycin hydrochloride. When costs were compared, a strategy starting with amoxicillin followed by azithromycin for nonresponders was favored, with costs approximately 15% lower than starting with azithromycin followed by amoxicillin. Strategies using clindamycin were significantly more expensive. The drug combination recommended by the Centers for Disease Control and Prevention (erythromycin followed by amoxicillin in nonresponders) was more expensive than amoxicillin-azithromycin and had one of the highest failure rates. Variation in the cost of the medications and in the effectiveness of the antibiotics under consideration did not significantly alter the findings.


CONCLUSIONS
For pregnant women infected with Chlamydia, initiating treatment with amoxicillin, 500 mg 3 times a day for 7 days, followed by a single 1-g dose of azithromycin for nonresponders is the most cost-effective strategy for treatment.
Hueston
W J
WJ
Eau Claire Family Medicine, Department of Family Medicine, University of Wisconsin-Madison Medical School, USA. huestowj@musc.edu
Lenhart
J G
JG
D000328:Adult; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D002690:Chlamydia Infections / Q000188:drug therapy* / Q000191:economics* / Q000382:microbiology; D002692:Chlamydia trachomatis / Q000187:drug effects / Q000302:isolation & purification; D002981:Clindamycin / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D004917:Erythromycin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D010406:Penicillins / Q000627:therapeutic use; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000191:economics* / Q000382:microbiology; D016896:Treatment Outcome; D014481:United States
D000900:Anti-Bacterial Agents; D010406:Penicillins; D002981:Clindamycin; D004917:Erythromycin; D000658:Amoxicillin; D017963:Azithromycin