Oral erythromycin prophylaxis vs watchful waiting in caring for newborns exposed to Chlamydia trachomatis.
BACKGROUND
Chlamydia trachomatis exposure at birth may cause conjunctivitis or pneumonia. Until recently, a course of oral erythromycin prophylaxis was recommended for C trachomatis-exposed neonates. However, recognition of an association between erythromycin and pyloric stenosis prompted a change to a watchful waiting recommendation under which only infants who develop symptomatic C trachomatis infection are treated with oral erythromycin.


OBJECTIVE
To compare erythromycin prophylaxis with watchful waiting for a hypothetical cohort of 100 000 neonates exposed to C trachomatis.


METHODS
In a decision tree, potential outcomes were C trachomatis conjunctivitis, C trachomatis pneumonia (which could require inpatient or outpatient therapy), no clinical disease, and pyloric stenosis. Published data were reviewed to derive probability point estimates and ranges. Estimated charges served as outcome measures.


RESULTS
Watchful waiting is less expensive than erythromycin prophylaxis ($15.1 million vs $28.3 million); prophylaxis prevents 5986 cases of C trachomatis pneumonia, including 1197 hospital admissions, but causes 3284 pyloric stenosis cases. (For every 30 infants given oral erythromycin prophylaxis, one additional case of pyloric stenosis would be expected to occur, and approximately 1.8 cases of C trachomatis pneumonia would be prevented.) In sensitivity analyses, if more than 3.4% of exposed neonates are hospitalized for C trachomatis pneumonia, prophylaxis becomes favored.


CONCLUSIONS
This study supports the watchful waiting recommendation for asymptomatic C trachomatis-exposed neonates. However, there are wide plausible ranges for pyloric stenosis risk after erythromycin administration and for the incidence of C trachomatis pneumonia severe enough to require hospitalization; under some combinations of these rates, prophylaxis could be favored.
Rosenman
Marc B
MB
Section of Children's Health Services Research, Regenstrief Institute, Indiana University School of Medicine, 1050 Wishard Boulevard, Indianapolis, IN 46202, USA. mrosenma@iupui.edu
Mahon
Barbara E
BE
Downs
Stephen M
SM
Kleiman
Martin B
MB
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019072:Antibiotic Prophylaxis; D002690:Chlamydia Infections / Q000188:drug therapy / Q000517:prevention & control*; D002692:Chlamydia trachomatis; D003234:Conjunctivitis, Bacterial / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D003663:Decision Trees; D004917:Erythromycin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018410:Pneumonia, Bacterial / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011707:Pyloric Stenosis / Q000139:chemically induced
D000900:Anti-Bacterial Agents; D004917:Erythromycin