Eritromicina vs. azitromicina nella terapia dell'infezione da chlamydia trachomatis in gravidanza

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This study compares the efficacy ana side effects of erythromycin and azithromycin in the treatment ofchlamydial cervicitis in pregnancy. Sixty-one pregnant women DNA positive antigen for Chlamydia trachomatis were considered in two groups, one treated with erythromycin 500 mg every 6 hours for 7 days, the other with azithromycin 1 g single dose. Three weeks after therapy was started, patients were assessed for treatment efficacy, side effects and compliance, and DNA probe assay was repeated. The efficacy results were similar (93.5%/90% respectively, P=0.06), azithromycin caused fewer gastrointestinal side effects (13.3%/54.8%, p=0.01) and found better compliance. Though azithromycin and erythromycin have similar efficacy, the one has fewer side effects and better compliance than the other. Azithromycin would seem so to be a prime therapeutic for chlamydial cervicitis in pregnant women.

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Azithromycin is a member of a new class of macrolides called azalydes. Although azithromycin resembles erythromycine there are significant differences in antibacterial activity and pharmacokinetic profile. Azithromycin is taken up by cells and the intracellular concentrations are significantly higher than serum concentrations. After a single oral dose of Ig, azithromycin has a long lasting effect--the tissue concentrations in the uterine and cervical tissues are kept above the minimal inhibitory concentration for Chlamydia trachomatis for more than 10 days. In order to achieve the maximal bioavailability and avoid side effects (gastrointestinal discomfort), azithromycin should be taken apart from meals (one hour before or two hours after meals). Azithromycin has no hepatotoxic potential and the possibility for drug interactions is not apparent. It is also recommended for use in pregnant women--FDA category B. A single oral dose of Ig azithromycin is the reasonable choice for the treatment of uncomplicated genital chlamydial infection.