클라미디아감염증 편집하기 (부분)

===임신부의 단순생식기클라미디아감염===

*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.<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. 

*Erythromycin estolate은 간독성 때문에 금기이다. 단지 erythromycin base 또는 erythromycin ethylsuccinate만 사용 가능하다.

 A   임신부 단순 생식기 클라미디아 감염의 권장 항균제 요법
     ⋅ Azithromycin 1g 경구 단회 요법 
     또는
     ⋅ Amoxicillin 500mg 1일 3회 경구 7일 요법
     또는
     ⋅ Erythromycin 500mg 1일 4회 경구 7일 요법
 B   복약순응도, 부작용, 효과 등을 고려할 때, 생식기 클라미디아 감염 임신부에서는 azithromycin 1g 경구 단회 요법이 권장되나 
     안전성 미확립 상태이므로 치료에 따른 이득과 위험을 고려하여 선택을 결정한다.

====클라미디아 난관염====

*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.<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.