Search

Chlamydia causes many human infections and should be treated aggressively. Tetracycline or doxycycline are the drugs of choice, but erythromycin can be used if a drug allergy is present or if tetracyclines are contraindicated. In the pregnant woman, aggressive treatment can improve neonatal outcome. In the United States, each year 155,000 infants are exposed to Chlamydia trachomatis during the birth process, and more than 100,000 will be infected. Of these, 75,000 will get conjunctivitis, and 30,000 will get pneumonia. In pregnancy, erythromycin is the drug of choice, with treatment recommended after initial culture and at term if repeat cultures are positive. If erythromycin is not tolerated, or the patient has an allergy to it, ampicillin or clindamycin may be effective alternatives.

The authors reviewed all documented cases of bacteremia in obstetric patients between 1975 and 1979, with emphasis on the clinical course. The incidence of bacteremia was 7.5:1000 obstetric admissions and 9.7% of those patients sampled. One hundred seventy-six bacteremic obstetric patients had the following diagnoses: endoparametritis (123), pyelonephritis (29), chorioamnionitis (14), and other (10). No deaths, clinical evidence of septic shock, or cases of postinfection endocarditis were found. The most common bloodstream isolates were Escherichia coli (57), group B streptococcus (28), and Bacteroides sp (26). The patients with endoparametritis had a fever index of 86.2 +/- 47.1F-hours, an average hospital stay of 6.5 +/- 3.1 days, a 7.3% rate of complications, and a 19.5% rate of failure of primary antibiotics. The patients with chorioamnionitis had a fever index of 32.7 +/- 48.9F-hours and an average hospital stay of 4.8 +/- 2.3 days. These clinical measures are comparable with those in the general population with the same diagnoses at the authors' hospital. In this obstetric population, prompt, vigorous treatment rendered the clinical course of bacteremic patients with genital infections remarkably similar to that of nonbacteremic patients with the same kinds of infection.

During a 4-year period, 48 obstetric patients with aerobic streptococcal bacteremia were identified. The isolates were group B (31); group D, enterococci (5); group A (4); group D, not enterococci (3); Streptococcus pneumoniae (3); and viridans streptococci (2). The most common diagnoses were endometritis (36) and chorioamnionitis (8). For all streptococcal genital infections, the clinical presentation included early-onset fever, often with few localizing signs. Only one patient had a chronic debilitating disease. There was an excellent correlation between genital and bloodstream isolates (36 of 42). Maternal response to therapy was good, with no deaths nor episodes of septic shock. Possible infectious complications developed in two fetuses and four neonates. The microbiologic and clinical features of aerobic streptococci were reviewed, and the outcome in obstetric patients and that in other adults were compared.

Ceftazidime in the breast milk of 11 puerperal women were determined by bioassay. Each patient received 2 g of ceftazidime intravenously every 8 h for 5 days. The mean (+/- standard deviation) ceftazidime concentrations in the milk were: 3.8 +/- 2.0 (before the next dose), 5.2 +/- 3.0 (1 h after), and 4.5 +/- 1.7 micrograms/ml (3 h after). Ceftazidime was excreted in breast milk at relatively constant levels between days 2 and 4 of therapy.