Antibiotics for gonorrhoea in pregnancy

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.

The Cochrane Pregnancy and Childbirth Group trials register (November 2001) and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 3, 2001) were searched.

Randomised 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 reviewer.

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 (odds ratio (OR) 2.40, 95% confidence interval (CI) 0.71-8.12), amoxicillin plus probenecid compared with ceftriaxone (OR 2.40, 95% CI 0.71-8.12) and ceftriaxone compared with cefixime (OR 1.22, 95% CI 0.16-9.04). 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.