Antibiotics for gonorrhoea in pregnancy

Abstract

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. 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. 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. Randomized trials of one regimen of antibiotic versus another in pregnant women with culture confirmed genital gonococcal infection. Eligibility and trial quality were assessed by one review author. 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. 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.]