Single-dose azithromycin versus erythromycin or amoxicillin for Chlamydia trachomatis infection during pregnancy: a meta-analysis of randomised controlled trials

Int J Antimicrob Agents. 2007 Sep;30(3):213-21. doi: 10.1016/j.ijantimicag.2007.04.015. Epub 2007 Jun 26.


This review aimed to compare data regarding the effectiveness and safety of azithromycin with alternative regimens in the treatment of pregnant women with Chlamydia trachomatis infection. PubMed and Scopus databases were searched to identify relevant randomised controlled trials (RCTs). The main analysis focused on comparison of azithromycin with erythromycin. In a secondary analysis, azithromycin was compared with erythromycin or amoxicillin. Eight RCTs studying 587 pregnant women with microbiologically documented C. trachomatis infection were included in the meta-analysis. Overall, there was no difference between azithromycin and erythromycin regarding treatment success in intention-to-treat patients (pooled odds ratio (OR)=2.66, 95% confidence interval (CI) 0.69-10.29) or in clinically evaluated patients (OR=1.46, 95% CI 0.56-3.78). Furthermore, azithromycin was associated with fewer gastrointestinal adverse events (OR=0.11, 95% CI 0.07-0.18), fewer total adverse events (OR=0.11, 95% CI 0.07-0.18), a smaller proportion of patients who withdrew from the study (OR=0.12, 95% CI 0.04-0.37) and better compliance (OR=23.7, 95% CI 9.34-60.14) than erythromycin. The results of the secondary analysis comparing azithromycin with erythromycin or amoxicillin were similar to those of the main analysis. In conclusion, azithromycin was associated with similar effectiveness but less adverse events compared with erythromycin or amoxicillin in the treatment of pregnant women with C. trachomatis infection.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Adult
  • Amoxicillin / adverse effects
  • Amoxicillin / economics
  • Amoxicillin / therapeutic use*
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / economics
  • Anti-Bacterial Agents / therapeutic use*
  • Azithromycin / adverse effects
  • Azithromycin / economics
  • Azithromycin / therapeutic use*
  • Chlamydia Infections / drug therapy*
  • Chlamydia Infections / economics
  • Chlamydia Infections / microbiology
  • Chlamydia trachomatis*
  • Costs and Cost Analysis
  • Databases, Factual
  • Erythromycin / adverse effects
  • Erythromycin / economics
  • Erythromycin / therapeutic use*
  • Female
  • Gastrointestinal Diseases / chemically induced
  • Humans
  • Male
  • Patient Compliance
  • Pregnancy
  • Randomized Controlled Trials as Topic


  • Anti-Bacterial Agents
  • Erythromycin
  • Amoxicillin
  • Azithromycin