March 1996
LISBON—The advanced generation macrolide clarithromycin appears to be an effective and well-tolerated antibiotic for the treatment of Chlamydia trachomatis in neonates, German investigators reported at The Third International Conference on Macrolides, Azalides, and Streptogramins.
Of 530 high-risk neonates tested, 49 (9.2%) were found to be infected with C trachomatis, said Heino Skopnik, MD, a Pediatrician at the Aachen University of Technology Children's Hospital in Aachen. Clarithromycin showed effective eradication of this pathogen in 39 (95%) of 41 patients treated with 15 mg/kg/day for 21 days, with test of cure taken 8 weeks after treatment. Only minor side effects were observed.
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C trachomatis can be transmitted to neonates during vaginal delivery or during pregnancy by chorioamnionitis, which can result in premature rupture of membranes and premature delivery, Skopnik said. When ignored or insufficiently treated, respiratory problems may develop. In addition, because of their high incidence (10%), chlamydial infections of neonates contribute to the overall morbidity in this age group.
Because of advantages over erythromycin such as higher efficacy, increased cellular bioavailability, and a better side-effect profile, Skopnik's group decided to evaluate clarithromycin for its ability to eradicate C trachomatis in neonates.
For the trial, nasopharyngeal and conjunctival swabs (two of each) were taken on the fourth day of life from all consecutive neonates admitted to the neonatal care unit at Skopnik's institution during a recent 6-month period to diagnose colonization with C trachomatis. Test-of-cure swabs were obtained 1 and 8 weeks after the end of treatment, respectively.
Forty nine patients tested positive at least once and were subsequently treated with clarithromycin for 21 days. Treatment was generally well tolerated.
Skopnik noted that although erythromycin is considered to be the "current best therapy" for C trachomatis infection in neonates, he believes clarithromycin represents an attractive alternative. "In fact, we found . . . that 25% of our neonates were non-responders after nearly 2 weeks of treatment with erythromycin, and the drug was associated with a high rate of side effects," he said. Based on this study, infected neonates at his institution are now routinely treated with clarithromycin.
Finally, Skopnik recommended that children and expectant mothers at high risk for C trachomatis infection should be screened regularly.
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