Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-analysis
| Autor: | Ornella Lincetto, Holger J. Schünemann, Andrew Zikic, Nathalie Broutet, Nancy Santesso, Teodora Wi |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Gastrointestinal Diseases Erythromycin Chlamydia trachomatis Azithromycin Electronic Articles Drug Administration Schedule Pyloric Stenosis Trimethoprim Pyloric stenosis law.invention Conjunctivitis Bacterial 03 medical and health sciences 0302 clinical medicine Bias Randomized controlled trial Risk Factors law Internal medicine conjunctivitis medicine Humans 030212 general & internal medicine Adverse effect azithromycin Chlamydia business.industry Infant Newborn General Medicine Chlamydia Infections medicine.disease Anti-Bacterial Agents Infectious Diseases Meta-analysis Pediatrics Perinatology and Child Health 030221 ophthalmology & optometry Female neonate business Original Articles and Commentaries medicine.drug |
| Zdroj: | Journal of the Pediatric Infectious Diseases Society |
| ISSN: | 2048-7207 2048-7193 |
| DOI: | 10.1093/jpids/piy060 |
| Popis: | In countries that lack prenatal screening and treatment of pregnant women for chlamydia, neonatal chlamydial conjunctivitis is still a common infection. Ours is the first systematic review and meta-analysis of treatment for neonatal chlamydial conjunctivitis. Background With the continued high prevalence of chlamydia worldwide and high risk of transfer from mothers to their infant during delivery, a need for safe and effective therapies for infants who acquire a chlamydial infection remains. We conducted a systematic review and meta-analysis of antibiotic treatments, including oral erythromycin, azithromycin, and trimethoprim, for neonatal chlamydial conjunctivitis. Methods We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) from their inception to July 14, 2017. We included randomized and nonrandomized studies that evaluated the effects of erythromycin, azithromycin, or trimethoprim in neonates with chlamydial conjunctivitis. A meta-analysis using a random-effects generic inverse-variance method was performed, and the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results We found 12 studies (n = 292 neonates) and were able to meta-analyze 7 studies that used erythromycin at a dose of 50 mg/kg body weight per day for 14 days. The clinical and microbiological cure were 96% (95% confidence interval [CI], 94%–100%) and 97% (95% CI, 95%–99%), respectively, and adverse gastrointestinal effects occurred in 14% (95% CI, 1%–28%) of the neonates. The microbiological cure in the study that assessed azithromycin at 20 mg/kg per day were 60% (95% CI, 27%–93%) when it was given in a single dose and 86% (95% CI, 61%–100%) when given in a 3-day course. Two studies reported compliance with treatments, and 1 study reported no pyloric stenosis events. Because of the risk of bias and the few neonates included across the studies, the certainty of evidence is low to very low. No studies assessed trimethoprim. Conclusions Although evidence suggests that erythromycin at 50 mg/kg per day for 14 days results in higher numbers of cure than does azithromycin, compliance and risk of pyloric stenosis related to their use for other infections in neonates will factor into treatment recommendations. More data are needed to compare these treatments directly. |
| Databáze: | OpenAIRE |
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