Epidemiologie und Nachweisverfahren von Chlamydia trachomatis bei Neugeborenen und die Behandlung mit Clarithromycin

摘要

As infections with Chlamydia trachomatis in neonates are a growing problem and the treatment with Erythromycin frequently shows side-effects and relatively often does not lead to complete eradication, in this prospective study we investigated tolerance and effectivity of the antibiotic therapy with Clarithromycin. 530 patients who were consecutively admitted to our neonatal ward from May 1992 to December 1993 were tested in this study. Two nasopharyngeal and two conjunctival swabs were taken on the fourth day of life at earliest for the detection of Chlamydia trachomatis (dtection by one EIA: IDEIA III-"OPTIMUN® CHLAMYDIA ELISA", Röhm Pharma GmbH, Darmstadt, BRD and by one geneprobe: PACE 2®, Gen-Probe, San Diego, USA or alternatively by a second EIA: VIDAS® Chlamydia, bioMérieux Vitek, Hazelwood, USA). In case of discrepant or indeterminate results new swabs were taken. All definitively positive patients were treated with Clarithromycin (15 mg/kg/d) for 21 Tage. Test-of-cure swabs for the proof of the eradication of Chlamydia trachomatis were taken one and eight weeks after the end of treatment, respectively. 49/530 neonates (9,2 %) were definitively positive. This incidence lies within the expected range. 47 patients were treated, 41 of them could be observed until the end of the follow-up period. 8 of 41 were still positive at the first test-of-cure. Only 2 of 41 proved to be still positive at the second test-of-cure. None of them showed symptoms of a persisting chlamydial infection. The IDEIA III® with integrated amplifier system seemed to be more sensitive than the geneprobe. The VIDAS®-Chlamydia test was not sensitive enough for this kind of specimen. Clarithromycin showed to be an effective and well tolerated antibiotic for the eradication of Chlamydia trachomatis in neonates.