클라미디아감염증 - 편집 역사

Seungju: /* 검체의 선택 */

2016-08-23T00:51:51Z

검체의 선택

Seungju: /* 국내 */

2016-08-23T00:50:32Z

국내

Seungju: /* 참고문헌 */

2016-08-03T00:42:04Z

참고문헌

Seungju: /* 성 파트너에 대한 통지 */

2016-08-03T00:40:20Z

성 파트너에 대한 통지

Seungju: /* 성 파트너에 대한 통지 */

2016-08-03T00:39:43Z

성 파트너에 대한 통지

Seungju: /* 장기 추적관찰 */

2016-08-03T00:37:33Z

장기 추적관찰

Seungju: /* 추적관찰 및 완치판정을 위한 검사 */

2016-08-03T00:36:32Z

추적관찰 및 완치판정을 위한 검사

Seungju: /* 클라미디아 직장감염 */

2016-08-03T00:35:59Z

클라미디아 직장감염

Seungju: /* 클라미디아 부고환-고환염 */

2016-08-03T00:35:25Z

클라미디아 부고환-고환염

Seungju: /* 임신부의 단순생식기클라미디아감염 */

2016-08-03T00:32:58Z

임신부의 단순생식기클라미디아감염

@@ 137번째 줄: / 137번째 줄: @@
 *법의학적 목적이 아닌 경우, 비침습성 검체는 환자의 불편감을 최소화 할 수 있기 때문에 핵산증폭검사를 이용하는 선별검사에 권장된다. 비침습성 검체로는 남성의 소변, 여성의 소변과 질도말 검체 등이 해당된다.
-*자궁내막 면봉체와 질 면봉검체는 동일한 검사결과를 보였다.<ref name="Vaginal swabs are the specimens of choice when screening for Chlamydia trachomatis and Neisseria gonorrhoeae: results from a multicenter evaluation of the APTIMA assays for both infections.">Schachter J, Chernesky MA, Willis DE, et al. Vaginal swabs are the specimens of choice when screening for Chlamydia trachomatis and Neisseria gonorrhoeae: results from a multicenter evaluation of the APTIMA assays for both infections. Sex Transm Dis 2005;32:725-728. </ref>(근거수준 2)
+*자궁내막 면봉검체와 질 면봉검체는 동일한 검사결과를 보였다.<ref name="Vaginal swabs are the specimens of choice when screening for Chlamydia trachomatis and Neisseria gonorrhoeae: results from a multicenter evaluation of the APTIMA assays for both infections.">Schachter J, Chernesky MA, Willis DE, et al. Vaginal swabs are the specimens of choice when screening for Chlamydia trachomatis and Neisseria gonorrhoeae: results from a multicenter evaluation of the APTIMA assays for both infections. Sex Transm Dis 2005;32:725-728. </ref>(근거수준 2)
 *의료진에 의한 질검체와환자자신의 자가 질면봉검체는 동일한 검사결과를 보였다.<ref name="Vaginal swabs are the specimens of choice when screening for Chlamydia trachomatis and Neisseria gonorrhoeae: results from a multicenter evaluation of the APTIMA assays for both infections.">Schachter J, Chernesky MA, Willis DE, et al. Vaginal swabs are the specimens of choice when screening for Chlamydia trachomatis and Neisseria gonorrhoeae: results from a multicenter evaluation of the APTIMA assays for both infections. Sex Transm Dis 2005;32:725-728. </ref><ref name="Evaluation of use of a single intravaginal swab to detect multiple sexually transmitted infections in active-duty military women.">Rompalo AM, Gaydos CA, Shah N, et al. Evaluation of use of a single intravaginal swab to detect multiple sexually transmitted infections in active-duty military women. Clin Infect Dis 2001;33:1455-1461. </ref>(근거수준 2)
-*체계적 고찰에 따른면 여성 핵산증폭검사에 있어서 자궁경부내막 검체가 첫소변에 비해 더 높은 민감도를 보였다.<ref name="Screening for gonorrhea and Chlamydia: a systematic review for the U.S. Preventive Services Task Force.">Zakher B, Cantor AG, Pappas M, Daeges M, Nelson HD.Screening for gonorrhea and Chlamydia: a systematic review for the U.S. Preventive Services Task Force.Ann Intern Med. 2014 Dec 16;161(12):884-93. </ref>(근거수준 1)따라서 핵산증폭검사를 위한 여성의 소변검체는 검체의 양과 방법에 따라 낮은 민감도를 보일 수도 있으므로, 주의를 요한다.
+*체계적 고찰에 따르면 여성 핵산증폭검사에 있어서 자궁경부내막 검체가 첫소변에 비해 더 높은 민감도를 보였다.<ref name="Screening for gonorrhea and Chlamydia: a systematic review for the U.S. Preventive Services Task Force.">Zakher B, Cantor AG, Pappas M, Daeges M, Nelson HD.Screening for gonorrhea and Chlamydia: a systematic review for the U.S. Preventive Services Task Force.Ann Intern Med. 2014 Dec 16;161(12):884-93. </ref>(근거수준 1)따라서 핵산증폭검사를 위한 여성의 소변검체는 검체의 양과 방법에 따라 낮은 민감도를 보일 수도 있으므로, 주의를 요한다.
 *남성 핵산증폭검사에 있어서 첫소변과 요도 면봉검체는 동일한 검사결과를 보였다. 하지만 요도를 통한 검체는 환자의 불편감을 유발하였다.<ref name="Multicenter evaluation of the BDProbeTec ET System for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine specimens, female endocervical swabs, and male urethral swabs.">Van Der Pol B, Ferrero DV, Buck-Barrington L, et al. Multicenter evaluation of the BDProbeTec ET System for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine specimens, female endocervical swabs, and male urethral swabs. J Clin Microbiol 2001;39:1008-1016. </ref><ref name="Ability of new APTIMA CT and APTIMA GC assays to detect Chlamydia trachomatis and Neisseria gonorrhoeae in male urine and urethral swabs.">Chernesky MA, Martin DH, Hook EW, et al. Ability of new APTIMA CT and APTIMA GC assays to detect Chlamydia trachomatis and Neisseria gonorrhoeae in male urine and urethral swabs. J Clin Microbiol 2005;43:127-131. </ref>(근거수준 2)

@@ 9번째 줄: / 9번째 줄: @@
 ====국내====
-*우리나라에서는 전염병예방법 3군에 속하며, 표본감시체계에 의해 전국 보건소 및 300여개 표본의료기관을 중심으로 발생현황을 파악하고 있는 성매개감염병이다. 표본감시의료기관의 의료인은 신고의 의무가 있다.
+*우리나라에서는 감염병의 예방 및 관리에 관한 법률에 따라 지정감염병에 속하며, 표본감시체계에 의해 전국 보건소 및 300여개 표본의료기관을 중심으로 발생현황을 파악하고 있는 성매개감염병이다. 표본감시의료기관의 의료인은 신고의 의무가 있다.
-:- 신고범위: 전염병환자
+:- 신고범위: 감염병환자
 :- 신고시기: 7일 이내
@@ 17번째 줄: / 17번째 줄: @@
 *우리나라에서는 2006년 이후 증가양상 보이고 있으며 2007년 3,196명, 2008년 3,501명으로 꾸준한 증가 추세에 있다.<ref name="2009년 성병관리지침”>Korea Centers for Disease Control and Prevention. 2009년 성병관리지침. 질병관리본부; 2009.</ref><ref name="Report from a Korea Centers for Disease Control and Prevention 2007”>Lee JK. Report from a Korea Centers for Disease Control and Prevention 2007. KCDC, 2008;98:127-130. </ref>
-*우리나라의 2008년 보고에 따르면 20-29세의 젊은 성인에서 매우 높게 나타났으며 남성에서 97명, 여성에서 3,404명으로 여성에서 높게 나타났다.
+*우리나라의 2010년 보고에 따르면 20-29세의 젊은 성인에서 매우 높게 나타났으며 남성에서 281명, 여성에서 2,703명으로 여성에서 높게 나타났다.
 *2003년 국내 대학생들에 대한 조사에서 클라미디아의 유병률은 3.7%로 나타났고, 남자는 3.1%, 여자는 5.0%의 유병률을 보였다.<ref name="국내 대학생들의 클라미디아 임균감염의 유병률 조사 및 성생활에 따른 위험인자 분석”>이승주, 하유신, 김세웅 등. 국내 대학생들의 클라미디아 임균감염의 유병률 조사 및 성생활에 따른 위험인자 분석. 대한비뇨기과학회지 2004:45:707-713. </ref>

← 이전 판		2016년 8월 3일 (수) 00:42 판
291번째 줄:		291번째 줄:

	==참고문헌==		==참고문헌==
−
−	~~1. Korea Centers for Disease Control and Prevention. 2009년 성병관리지침. 질병관리본부; 2009.~~
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−	3. 이승주, 하유신, 김세웅 등. 국내 대학생들의 클라미디아 임균감염의 유병률 조사 및 성생활에 따른 위험인자 분석. 대한비뇨기과학회지 2004:45:707-713.
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−	4. Lee SJ, Cho YH, Kim CS, et al. Screening for Chlamydia and gonorrhea by strand displacement amplification in homeless adolescents attending youth shelters in Korea. J Korean Med Sci. 2004;19:495-500.
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−	~~5. 이승주, 조용현. 클라미디아 유병률 조사에 관한 연구. 질병관리본부; 2005.~~
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−	~~15. Marrazzo JM, Whittington WL, Celum CL, et al. Urine-based screening for Chlamydia trachomatis in men attending sexually transmitted disease clinics. Sex Transm Dis 2001;28:219-225.~~
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−	~~16. Creighton S, Tenant-Flowers M, Taylor CB, Miller R, Low N. Co-infection with gonorrhoea and chlamydia: how much is there and what does it mean? Int J STD AIDS 2003;14:109-113.~~
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−	23. Gaydos CA, Quinn TC, Willis D, et al. Performance of the APTIMA Combo 2 assay for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in female urine and endocervical swab specimens. J Clin Microbiol 2003;41:304-309.
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−	24. Schachter J, Chernesky MA, Willis DE, et al. Vaginal swabs are the specimens of choice when screening for Chlamydia trachomatis and Neisseria gonorrhoeae: results from a multicenter evaluation of the APTIMA assays for both infections. Sex Transm Dis 2005;32:725-728.
−
−	25. Rompalo AM, Gaydos CA, Shah N, et al. Evaluation of use of a single intravaginal swab to detect multiple sexually transmitted infections in active-duty military women. Clin Infect Dis 2001;33:1455-1461.
−
−	26. Zakher B, Cantor AG, Pappas M, Daeges M, Nelson HD.Screening for gonorrhea and Chlamydia: a systematic review for the U.S. Preventive Services Task Force.Ann Intern Med. 2014 Dec 16;161(12):884-93.
−
−	27. Van Der Pol B, Ferrero DV, Buck-Barrington L, et al. Multicenter evaluation of the BDProbeTec ET System for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine specimens, female endocervical swabs, and male urethral swabs. J Clin Microbiol 2001;39:1008-1016.
−
−	28. Chernesky MA, Martin DH, Hook EW, et al. Ability of new APTIMA CT and APTIMA GC assays to detect Chlamydia trachomatis and Neisseria gonorrhoeae in male urine and urethral swabs. J Clin Microbiol 2005;43:127-131.
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−	~~33. Hammerschlag MR, Golden NH, Oh MK, et al. Single dose of azithromycin for the treatment of genital chlamydial infections in adolescents. J Pediatr 1993;122:961-965.~~
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−	~~51. Ross JDC. British Association for Sexual Health and HIV (BASHH). United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease. London: BASHH; 2005.~~
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−	~~52. British Association for Sexual Health and HIV (BASHH). 2001 National Guideline for the Management of epididymo-orchitis. London: BASHH; 2001.~~
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−	~~53. Richardson D, Goldmeier D. Lymphogranuloma venereum: an emerging cause of proctitis in men who have sex with men. Int J STD AIDS 2007;18:11-14.~~
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−	55. Scott Lamontagne D, Baster K, Emmett L, et al. Incidence and reinfection rates of genital chlamydial infection among women aged 16-24 years attending general practice, family planning and genitourinary medicine clinics in England: a prospective cohort study by the Chlamydia Recall Study Advisory Group. Sex Transm Infect 2007;83:292303.
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−	~~56. Hosenfeld CB, Workowski KA, Berman S, et al. Repeat infection with chlamydia and gonorrhea among females: a systematic review of the literature. Sex Transm Dis 2009;36:478–489.~~
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−	57. Arya OP, Alergant CD, Annels EH, et al. Management of non-specific urethritis in men. Evaluation of six treatment regimens and effect of other factors including alcohol and sexual intercourse. Br J Vener Dis 1978;54:414-421.
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−	~~59. British Association for Sexual Health and HIV (BASHH). 2006 UK National Guideline for the Management of Genital Tract Infection with Chlamydia trachomatis. London: BASHH; 2006.~~

@@ 286번째 줄: / 286번째 줄: @@
       파트너는 검진받을 것이 권장된다.
-*클라미디아감염 유무에 대한 검진을 받은 성 파트너는 검사결과 음성이 나오더라도 상관없이 치료를 바로 시작해야 한다.32,33
+*클라미디아감염 유무에 대한 검진을 받은 성 파트너는 검사결과 음성이 나오더라도 상관없이 치료를 바로 시작해야 한다.<ref name="National guideline for the management of Chlamydia trachomatis genital tract infection.">Horner PJ, Caul EO. National guideline for the management of Chlamydia trachomatis genital tract infection. Sex Trans Inf 1999;75(Suppl 1):S4-8. </ref><ref name="National Guideline for the Management of Chlamydia trachomatis.">Clinical Effectiveness Group (Association of Genitourinary Medicine and the Medical Society for the Study of Venereal Diseases). National Guideline for the Management of Chlamydia trachomatis. Genital Tract Infection. 2001</ref>
   D   검진받은 파트너는 검사결과에 상관없이 클라미디아감염 치료가 권장된다.

@@ 276번째 줄: / 276번째 줄: @@
 ===성 파트너에 대한 통지===
-*치료받기 이전에 접촉했던 성 파트너에 대한 치료는 재감염의 예방에 중요하다.60따라서 성 파트너에 대한 통지 및 관리는 클라미디아 감염 치료에 필수 요소이다.61(근거수준 2)
+*치료받기 이전에 접촉했던 성 파트너에 대한 치료는 재감염의 예방에 중요하다.<ref name="Management of non-specific urethritis in men. Evaluation of six treatment regimens and effect of other factors including alcohol and sexual intercourse.">Arya OP, Alergant CD, Annels EH, et al. Management of non-specific urethritis in men. Evaluation of six treatment regimens and effect of other factors including alcohol and sexual intercourse. Br J Vener Dis 1978;54:414-421. </ref>따라서 성 파트너에 대한 통지 및 관리는 클라미디아 감염 치료에 필수 요소이다.<ref name="Compliance strategies in a clinic for treatment of sexually transmitted diseases.">Kroger F. Compliance strategies in a clinic for treatment of sexually transmitted diseases. Sex Transm Dis 1980;7:178-182. </ref>(근거수준 2)
   C   클라미디아 감염증 환자에게는 반드시 성 파트너에게 통지하도록 상담한다.
-*아직 통지해야 할 성 파트너의 범위에 대한 명확한 근거는 없지만, 증상이 있는 남성, 그리고 여성과 증상이 없는 남성을 구별하여 다음과 같은 기간이 권장되고 있다.62(근거수준 4)
+*아직 통지해야 할 성 파트너의 범위에 대한 명확한 근거는 없지만, 증상이 있는 남성, 그리고 여성과 증상이 없는 남성을 구별하여 다음과 같은 기간이 권장되고 있다.<ref name="2006 UK National Guideline for the Management of Genital Tract Infection with Chlamydia trachomatis.">British Association for Sexual Health and HIV (BASHH). 2006 UK National Guideline for the Management of Genital Tract Infection with Chlamydia trachomatis. London: BASHH; 2006. </ref>(근거수준 4)
   D   증상이 있는 남성 클라미디아 환자에서 증상 발현으로부터 8주 이내에 성접촉한 모든 파트너는 평가 받을 것이 권장된다.

@@ 252번째 줄: / 252번째 줄: @@
 ===장기 추적관찰===
-*영국에서 수행된 연구에 따르면 치료된 환자 100명당 재감염이 21.1-29.9명에서 발생하였다.58체계적고찰에 따르면 클라미디아감염이 있는 모든 사람들은 재감염의 위험이 높기 때문에 치료 후 3-6개월 경에 반복검사를 받아야 한다.59(근거수준 1)
+*영국에서 수행된 연구에 따르면 치료된 환자 100명당 재감염이 21.1-29.9명에서 발생하였다.<ref name="Incidence and reinfection rates of genital chlamydial infection among women aged 16-24 years attending general practice, family planning and genitourinary medicine clinics in England: a prospective cohort study by the Chlamydia Recall Study Advisory Group.">Scott Lamontagne D, Baster K, Emmett L, et al. Incidence and reinfection rates of genital chlamydial infection among women aged 16-24 years attending general practice, family planning and genitourinary medicine clinics in England: a prospective cohort study by the Chlamydia Recall Study Advisory Group. Sex Transm Infect 2007;83:292303. </ref>체계적고찰에 따르면 클라미디아감염이 있는 모든 사람들은 재감염의 위험이 높기 때문에 치료 후 3-6개월 경에 반복검사를 받아야 한다.<ref name="Repeat infection with chlamydia and gonorrhea among females: a systematic review of the literature.">Hosenfeld CB, Workowski KA, Berman S, et al. Repeat infection with chlamydia and gonorrhea among females: a systematic review of the literature. Sex Transm Dis 2009;36:478–489. </ref>(근거수준 1)
   D   장기 추적검사는 3-6개월 경에 시행하도록 권장되며, 성 파트너가 바뀌었을 경우는 더 앞당겨 질 수 있다.

@@ 241번째 줄: / 241번째 줄: @@
 :– 모든 임신부
-*치료로 사멸한 미생물의 유전자에 의한 핵산증폭검사 위양성 결과가 나올 수 있으므로, 완치판정을 위한 검사 시 주의하여야 한다.57(근거수준 3)
+*치료로 사멸한 미생물의 유전자에 의한 핵산증폭검사 위양성 결과가 나올 수 있으므로, 완치판정을 위한 검사 시 주의하여야 한다.<ref name="Molecular amplification assays to detect chlamydial infections in urine specimens from high school female students and to monitor the persistence of chlamydial DNA after therapy.">Gaydos CA, Crotchfelt KA, Howell MR, et al. Molecular amplification assays to detect chlamydial infections in urine specimens from high school female students and to monitor the persistence of chlamydial DNA after therapy. J Infect Dis 1998;177:417-424. </ref>(근거수준 3)
   D   클라미디아감염증을 치료받은 모든 환자는 2-4주 이내에 추적관찰을 위해 내원하도록 한다

@@ 219번째 줄: / 219번째 줄: @@
   D   클라미디아 직장감염에서는 azithromycin 1g 경구 단회 요법 또는 doxycycline 100mg 1일 2회 경구 7일 요법이 권장된다.
-*클라미디아 혈청형 L1-3에 의한 감염인 성병림프육아종 (lymphogranuloma venereum, LGV)이 의심될 경우 보다 장기간의 doxycycline 치료가 필요하다.56(근거수준 4)
+*클라미디아 혈청형 L1-3에 의한 감염인 성병림프육아종 (lymphogranuloma venereum, LGV)이 의심될 경우 보다 장기간의 doxycycline 치료가 필요하다.<ref name="Lymphogranuloma venereum: an emerging cause of proctitis in men who have sex with men.">Richardson D, Goldmeier D. Lymphogranuloma venereum: an emerging cause of proctitis in men who have sex with men. Int J STD AIDS 2007;18:11-14. </ref>(근거수준 4)
   D   성병림프육아종 (lymphogranuloma venereum, LGV)에서는 doxycycline 100mg 1일 2회 경구 21일 요법이 권장된다.

@@ 209번째 줄: / 209번째 줄: @@
 ===클라미디아 부고환-고환염===
-*클라미디아 부고환-고환염에 관한 단독적인 연구결과는 없다. 적절한 클라미디아 치료에도 불구하고 고환-부고환염 증상이나 징후를 계속 호소할 때, BASHH의 지침에 따르면 다음과 같은 항균제 치료를 권장하고 있다.55(근거수준 4)
+*클라미디아 부고환-고환염에 관한 단독적인 연구결과는 없다. 적절한 클라미디아 치료에도 불구하고 고환-부고환염 증상이나 징후를 계속 호소할 때, BASHH의 지침에 따르면 다음과 같은 항균제 치료를 권장하고 있다.<ref name="2001 National Guideline for the Management of epididymo-orchitis.">British Association for Sexual Health and HIV (BASHH). 2001 National Guideline for the Management of epididymo-orchitis. London: BASHH; 2001. </ref>(근거수준 4)
   D   클라미디아 부고환-고환염에서는 doxycycline 100mg 1일 2회 경구 14일 요법이 권장된다.

@@ 182번째 줄: / 182번째 줄: @@
 ===임신부의 단순생식기클라미디아감염===
-*Amoxicillin, erythromycin과 azithromycin을 비교한 임상연구에서 비슷한 미생물학적, 임상적 치유율(>90%)을 보였지만 erythromycin에서 더 많은 위장관 장애를 보였다. 45-53 (근거수준 1)
+*Amoxicillin, erythromycin과 azithromycin을 비교한 임상연구에서 비슷한 미생물학적, 임상적 치유율(>90%)을 보였지만 erythromycin에서 더 많은 위장관 장애를 보였다. <ref name="Double-blind randomized study comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy">Magat AH, Alger LS, Nagey DA, Hatch V, Lovchik JC. Double-blind randomized study comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy. Obstet Gynecol 1993;81(5 Pt 1):745-749. </ref><ref name="A randomized trial of azithromycin versus amoxicillin for the treatment of Chlamydia trachomatis in pregnancy.">Kacmar J, Cheh E, Montagno A, Peipert JF. A randomized trial of azithromycin versus amoxicillin for the treatment of Chlamydia trachomatis in pregnancy. Infect Dis Obstet Gynecol 2001;9:197-202. </ref><ref name="Single-dose azithromycin for Chlamydia in pregnant women.">Wehbeh HA, Ruggeirio RM, Shahem S, Lopez G, Ali Y. Single-dose azithromycin for Chlamydia in pregnant women. J Reprod Med 1998;43: 509-514. </ref><ref name="Chlamydia in pregnancy: a randomized trial of azithromycin and erythromycin.">Adair CD, Gunter M, Stovall TG, McElroy G, Veille JC, Ernest JM. Chlamydia in pregnancy: a randomized trial of azithromycin and erythromycin. Obstet Gynecol 1998;91:165-168. </ref><ref name="Randomised comparison of amoxycillin and erythromycin in treatment of genital chlamydial infection in pregnancy.">Alary M, Joly JR, Moutquin JM, et al. Randomised comparison of amoxycillin and erythromycin in treatment of genital chlamydial infection in pregnancy. Lancet 1994;344:1461-1465. </ref><ref name="Azithromycin and erythromycin in the treatment of cervical chlamydial infection during pregnancy.">Bush MR, Rosa C. Azithromycin and erythromycin in the treatment of cervical chlamydial infection during pregnancy. Obstet Gynecol 1994;84:61-63. </ref><ref name="Treatment of genital Chlamydia trachomatis infection in pregnancy.">Genc MR. Treatment of genital Chlamydia trachomatis infection in pregnancy. Best Pract Res Clin Obstet Gynaecol 2002;16:913-922. </ref><ref name="A randomized controlled trial comparing amoxicillin and azithromycin for the treatment of Chlamydia trachomatis in pregnancy.">Jacobson GF, Autry AM, Kirby RS, Liverman EM, Motley RU. A randomized controlled trial comparing amoxicillin and azithromycin for the treatment of Chlamydia trachomatis in pregnancy. Am J Obstet Gynecol 2001;184: 13521354. </ref><ref name="A randomized, prospective trial comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy.">Silverman NS, Sullivan M, Hochman M, Womack M, Jungkind DL. A randomized, prospective trial comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy. Am J Obstet Gynecol 1994;170:829-831. </ref>(근거수준 1)
-*임신부에서의 azithromycin에 대한 안전성은 아직 미확립 상태이지만, 많은 전문가들은 안전한 것으로 생각한다.46-48,50-52
+*임신부에서의 azithromycin에 대한 안전성은 아직 미확립 상태이지만, 많은 전문가들은 안전한 것으로 생각한다.<ref name="A randomized trial of azithromycin versus amoxicillin for the treatment of Chlamydia trachomatis in pregnancy.">Kacmar J, Cheh E, Montagno A, Peipert JF. A randomized trial of azithromycin versus amoxicillin for the treatment of Chlamydia trachomatis in pregnancy. Infect Dis Obstet Gynecol 2001;9:197-202. </ref><ref name="Single-dose azithromycin for Chlamydia in pregnant women.">Wehbeh HA, Ruggeirio RM, Shahem S, Lopez G, Ali Y. Single-dose azithromycin for Chlamydia in pregnant women. J Reprod Med 1998;43: 509-514. </ref><ref name="Chlamydia in pregnancy: a randomized trial of azithromycin and erythromycin.">Adair CD, Gunter M, Stovall TG, McElroy G, Veille JC, Ernest JM. Chlamydia in pregnancy: a randomized trial of azithromycin and erythromycin. Obstet Gynecol 1998;91:165-168. </ref><ref name="Azithromycin and erythromycin in the treatment of cervical chlamydial infection during pregnancy.">Bush MR, Rosa C. Azithromycin and erythromycin in the treatment of cervical chlamydial infection during pregnancy. Obstet Gynecol 1994;84:61-63. </ref><ref name="Treatment of genital Chlamydia trachomatis infection in pregnancy.">Genc MR. Treatment of genital Chlamydia trachomatis infection in pregnancy. Best Pract Res Clin Obstet Gynaecol 2002;16:913-922. </ref><ref name="A randomized controlled trial comparing amoxicillin and azithromycin for the treatment of Chlamydia trachomatis in pregnancy.">Jacobson GF, Autry AM, Kirby RS, Liverman EM, Motley RU. A randomized controlled trial comparing amoxicillin and azithromycin for the treatment of Chlamydia trachomatis in pregnancy. Am J Obstet Gynecol 2001;184: 13521354. </ref>
 *Doxycycline과 quinolone제재는 임신부와 수유중인 산모에게는 금기이다.
@@ 203번째 줄: / 203번째 줄: @@
 *클라미디아 난관염에 관한 단독적인 연구결과는 없다. 적절한 클라미디아 치료에도 불구하고 증상이나 징후를 계속 호소할 때, 클라미디아 난관염을 의심해 보아야 하는 점을 보면 단순 생식기 클라미디아 감염증 치료만으로 부족함을 시사한다.
-*British Association for Sexual Health and HIV (BASHH)의 지침에 따르면 다음과 같은 항생제 치료를 권장하고 있다.51(근거수준 4)
+*British Association for Sexual Health and HIV (BASHH)의 지침에 따르면 다음과 같은 항생제 치료를 권장하고 있다.<ref name="United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease.">Ross JDC. British Association for Sexual Health and HIV (BASHH). United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease. London: BASHH; 2005. </ref>(근거수준 4)
   D   클라미디아 난관염에서는 doxycycline 100mg 1일 2회 경구 14일 + metronidazole 500mg 1일 2회 경구 14일 요법이 권장된다.