The greatest in quantity commonly r...

The greatest in quantity commonly reported sexually transmitted disease in the United States is genital infection with Chlamydia trachomatis. This infection, when current during delivery, puts newborns at risk of developing conjunctivitis and pneumonia in the first not many months of life. An estimated 100000 newborns are expos to C trachomatis annually. Until lately the recommendation was to treat these infants with a 14-day course of oral erythromycin. However, the use of this medicine in newborns has been associated with an increased risk of pyloric stenosis. Because of this association, the popular recommendation is watchful waiting and treating infants with erythromycin single after they develop symptoms related to C trachomatis exposing There currently are no studies determining the risks and benefits of this strategy. Rosenman and associates compared the use of erythromycin prophylaxis with watchful waiting in a hypothetic cohort of neonates expos to C trachomatis.

The contemplation design was a decision tree analysis of 100000 neonates (see accompanying figure). Potential consequences included C. trachomatis conjunctivitis, C trachomatis pneumonia (inpatient or outpatient), no clinical disease, and pyloric stenosis. The authors searched the literature to determine probability point estimations and ranges. They used estimated costlinesss for each strategy as an consequence measure.

Using the decision tree analysis, prophylaxis with oral erythromycin in neonates after in all senses to C. trachomatis would obstruct 5,986 cases of C. trachomatis pneumonia, including 1197 hospital admissions. However, the use of oral erythromycin would increase by dint of 3,284 the number of neonates who unraveled pyloric stenosis. For every 30 infants treated with erythromycin, united additional case of pyloric stenosis would present itself The prophylaxis would prevent 18 cases of pneumonia through 30 neonates treated. A richness analysis established that watchful waiting would preciousness $15.1 million annually, while prophylaxis would charge $28.3 million. In another analysis of the data, if more than 34 percent of the neonates were hospitalized with pneumonia, prophylaxis with oral erythromycin would become more favorable. The authors close that their study supports the choice of watchful waiting for asymptomatic neonates who are expos to C trachomatis. They add that, in one circumstances, erythromycin prophylaxis may be appropriate because of the incidence of pneumonia requiring hospitalization.

Rosenman MB et al. Oral erythromycin prophylaxis v watchful waiting in caring for newborns expos to Chlamydia trachomatis. Arch Pediatr Adolesc M June 2003;157:565-71

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group