Prophylaxis of low-risk cesarean sections
Volume 162 Number 2
10. Ehrenkranz NJ. The efficacy of a Florida hospital consortium for infection control. Infect Control 1986;7: 321-6. 11. Bierman EL. Obesity. In: Beeson PB, McDermott W. Wyngaarden ]B, eds. Cecil textbook of medicine. 15th ed. Philadelphia: WB Saunders, 1979: 1678-80. 12. Bennett lV, Brachman PS. Hospital infections. 1st ed. Boston: Little, Brown. 1979. 13. Burke ]F. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery 1961 ;50: 161-8. 14. Armitage P. Statistical methods in medical research. New York: Wiley, 1971. 15. Breslow NE, Day NE. Statistical methods in cancer research. The analysis of case-control studies. Lyon: International Agency for Research on Cancer, 1980, vol 1.
16. Freeman MP, Cromwell J. Reimbursement of sole community hospitals under Medicare's prospective payment system. Health Care Financ Rev 1987;9:39-54. 17. Cymer WE. Health care financing trends: update on provider input price indexes. Health Care Finane Rev 1988;9:89-94. 18. Placek Pl. Taffel SM, Moien M. Cesarean rate increases in 1985 [Letter]. Am] Pub Health 1987;77:241-2. 19. de Reget RH, Minkoff HL, Feldman], Schwarz RH. Relation of private or clinic care to the cesarean birth rate. N Engl] Med 1986;315:619-24. 20. Shapiro ED. Murphy TV, Wald ER, Brady CA. The protective efficacy of Hemophzlus b polysaccharide vaccine. ]AMA 1988;260:1419-22.
Clindamycin therapy for Chlamydia trachomatis in women William F. Campbell, PhD, and Melvin G. Dodson, MD, PhD Johnson City, Tennessee The population for this study consisted of 4013 sexually active women seen for family planning. Culture for Chlamydia trachomatis yielded an isolation rate of 6.1%. Women aged 16 to 25 accounted for 81.7% of the C. trachoma tis infections, while those younger than 16 or older than 35 accounted for only 2.4% of the infections. Of the 246 patients whose cultures were positive for C. trachomatis, 159 (65%) were asymptomatic. The incidence of C. trachomatis was 11.2% among those with symptoms but only 6.4% among the asymptomatic group. Among 63 patients with Neisseria gonorrhoeae (who were excluded from the study), 26 (41.3%) also were infected by C. trachomatis. There were no microbiologic drug failures with erythromycin or clindamycin. Of 56 patients who enrolled in the clindamycin arm of the protocol, 48 (85.7%) completed therapy and experienced microbiologic and clinical cures. In contrast, erythromycin therapy was completed by only 25 of 57 women (43.9%) enrolled. The number of side effect failures for erythromycin was 22 of 57 (38.6%). This was more than five times the number of side effect failures for clindamycin (4 of 56, or 7.1%). (AM J OSSTET GVNECOL1990;162:343-7.)
Key words: Clindamycin, erythromycin, Chlamydza trachomatis, endocervicitis
Chlamydia tmchomatis currently is the most common sexually transmitted disease in the United States I.2 and is two to five times more prevalent than Neisseria gonorrhoeae. [.ol There are an estimated 3 to 5 million new cases of C. trachomatis infection each year in the United States alone. [ The incidence of C. trachomatis in sexually active women at risk is 6% to 23%. [ I Coinfec-
From the Departments of MicrobIOlogy and Obstetncs and Gynecology, College of Medicine, ElLlt Tennessee State UnlVemty. ThIS work was supported b.V a grant from The Upjohn Company, Kalamazoo, Mlch Received for publzcatlOn May 10, 1989; reVISed July 24, 1989; accepted September 12, 1989. Repnnt reque,t.l: William F. Campbell, PhD, Department of MicrobIOlogy. College of Medicine, East Tennessee State Umversi/'V, Johnson City, TN 37614. 611116685
tion by C, trachomatis and N. gonorrhoeae is quite common; one quarter to one half of the patients with N. gonorrhoeae also are infected by C. trachomatis." The treatment of choice for C. trachomatis infection is tetracycline or its derivatives. Erythromycin is recommended as the drug of choice in patients who are intolerant or allergic to tetracycline and in pregnant patients. Considering the number of cases of C. trachomatis and the incidence of drug intolerance, contraindications, and individual allergies, the availability of alternative therapeutic modalities would be of value. Clindamycin previously has been demonstrated to have in vitro activity against C. trachomatis similar to erythromycin.' However, clinical trials have been very limited. Bowie et al. 6 reported that a 7-day clindamycin regimen of 600 mg t.i.d. was only partially effective for the treatment of chlamydial urethritis in men. Wasser-
343
344
Campbell and Dodson
February 1990 Am J Obstet Gynecol
Table I. Age distribution of patients with chlamydial cervicitis Posllive
Cultures
Age (yr)
No. of patzents
n
%
lncidence*
Volume 162 Number 2
10. Ehrenkranz NJ. The efficacy of a Florida hospital consortium for infection control. Infect Control 1986;7: 321-6. 11. Bierman EL. Obesity. In: Beeson PB, McDermott W. Wyngaarden ]B, eds. Cecil textbook of medicine. 15th ed. Philadelphia: WB Saunders, 1979: 1678-80. 12. Bennett lV, Brachman PS. Hospital infections. 1st ed. Boston: Little, Brown. 1979. 13. Burke ]F. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery 1961 ;50: 161-8. 14. Armitage P. Statistical methods in medical research. New York: Wiley, 1971. 15. Breslow NE, Day NE. Statistical methods in cancer research. The analysis of case-control studies. Lyon: International Agency for Research on Cancer, 1980, vol 1.
16. Freeman MP, Cromwell J. Reimbursement of sole community hospitals under Medicare's prospective payment system. Health Care Financ Rev 1987;9:39-54. 17. Cymer WE. Health care financing trends: update on provider input price indexes. Health Care Finane Rev 1988;9:89-94. 18. Placek Pl. Taffel SM, Moien M. Cesarean rate increases in 1985 [Letter]. Am] Pub Health 1987;77:241-2. 19. de Reget RH, Minkoff HL, Feldman], Schwarz RH. Relation of private or clinic care to the cesarean birth rate. N Engl] Med 1986;315:619-24. 20. Shapiro ED. Murphy TV, Wald ER, Brady CA. The protective efficacy of Hemophzlus b polysaccharide vaccine. ]AMA 1988;260:1419-22.
Clindamycin therapy for Chlamydia trachomatis in women William F. Campbell, PhD, and Melvin G. Dodson, MD, PhD Johnson City, Tennessee The population for this study consisted of 4013 sexually active women seen for family planning. Culture for Chlamydia trachomatis yielded an isolation rate of 6.1%. Women aged 16 to 25 accounted for 81.7% of the C. trachoma tis infections, while those younger than 16 or older than 35 accounted for only 2.4% of the infections. Of the 246 patients whose cultures were positive for C. trachomatis, 159 (65%) were asymptomatic. The incidence of C. trachomatis was 11.2% among those with symptoms but only 6.4% among the asymptomatic group. Among 63 patients with Neisseria gonorrhoeae (who were excluded from the study), 26 (41.3%) also were infected by C. trachomatis. There were no microbiologic drug failures with erythromycin or clindamycin. Of 56 patients who enrolled in the clindamycin arm of the protocol, 48 (85.7%) completed therapy and experienced microbiologic and clinical cures. In contrast, erythromycin therapy was completed by only 25 of 57 women (43.9%) enrolled. The number of side effect failures for erythromycin was 22 of 57 (38.6%). This was more than five times the number of side effect failures for clindamycin (4 of 56, or 7.1%). (AM J OSSTET GVNECOL1990;162:343-7.)
Key words: Clindamycin, erythromycin, Chlamydza trachomatis, endocervicitis
Chlamydia tmchomatis currently is the most common sexually transmitted disease in the United States I.2 and is two to five times more prevalent than Neisseria gonorrhoeae. [.ol There are an estimated 3 to 5 million new cases of C. trachomatis infection each year in the United States alone. [ The incidence of C. trachomatis in sexually active women at risk is 6% to 23%. [ I Coinfec-
From the Departments of MicrobIOlogy and Obstetncs and Gynecology, College of Medicine, ElLlt Tennessee State UnlVemty. ThIS work was supported b.V a grant from The Upjohn Company, Kalamazoo, Mlch Received for publzcatlOn May 10, 1989; reVISed July 24, 1989; accepted September 12, 1989. Repnnt reque,t.l: William F. Campbell, PhD, Department of MicrobIOlogy. College of Medicine, East Tennessee State Umversi/'V, Johnson City, TN 37614. 611116685
tion by C, trachomatis and N. gonorrhoeae is quite common; one quarter to one half of the patients with N. gonorrhoeae also are infected by C. trachomatis." The treatment of choice for C. trachomatis infection is tetracycline or its derivatives. Erythromycin is recommended as the drug of choice in patients who are intolerant or allergic to tetracycline and in pregnant patients. Considering the number of cases of C. trachomatis and the incidence of drug intolerance, contraindications, and individual allergies, the availability of alternative therapeutic modalities would be of value. Clindamycin previously has been demonstrated to have in vitro activity against C. trachomatis similar to erythromycin.' However, clinical trials have been very limited. Bowie et al. 6 reported that a 7-day clindamycin regimen of 600 mg t.i.d. was only partially effective for the treatment of chlamydial urethritis in men. Wasser-
343
344
Campbell and Dodson
February 1990 Am J Obstet Gynecol
Table I. Age distribution of patients with chlamydial cervicitis Posllive
Cultures
Age (yr)
No. of patzents
n
%
lncidence*
