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Use of amoxicillin is currently the most promising direction in the therapy of urogenital chlamydia during pregnancy. This macrolide antibiotic has unique characteristics: high levels of absorption and stability in acidic medium, a high concentration in tissues, long half-life, ability to penetrate into the cell, where localized pathogen Chlamydia trachomatis, and the ability to block the phase transformation of elementary bodies of chlamydia in metabolically active reticular cells [ 14].A number of randomized comparative studies confirm the high efficacy of azithromycin after a single oral dose of 1 g (97-100%), a significant reduction in the incidence of side effects from the gastrointestinal tract (7,4% in comparison with that of using erythromycin 38.8% ), no adverse effects on the fetus [5, 23]. In a multicenter study, which included 347 patients, microbiological cure with azithromycin was achieved in 97% of cases and clinical cure in 86% of cases. At the same time, according to Stamm et al. [21], in 3 pregnant 5 weeks after therapy was to buy amoxicillin. However, in this case we can not categorically speak of recurrent infections, it is impossible to reliably exclude the fact reinfetsirovaniya. Nevertheless, the maximum (of the available at present drugs) therapy and cost-effectiveness, combined with good tolerability, ease of use and safety of azithromycin can be considered as the drug of choice in the treatment of urogenital chlamydial infection during pregnancy.
Of the macrolides, in addition to erythromycin and azithromycin for treatment of chlamydial infection during pregnancy G. Rigway [18] suggests using josamycin 500 mg 2 times a day for 7 days. These Russian researchers (JK Skripkin et al. [4], NS Potekaev et al. [2]) demonstrate the clinical efficacy of 97.2% to 100%, which is guaranteed by a high concentration of josamycin in the tissues, and well as its safety for pregnant women and children. However, these studies are not placebo-controlled, which reduces their credibility, and most importantly - small groups of pregnant women can not assess the real safety of this drug. Clinical experience with the same josamycin for the treatment of chlamydia during pregnancy is very limited, so few adverse perinatal outcomes may go undetected.
Recently published some reports on the use in the treatment of urogenital chlamydial infection in pregnant roksitromitsina 300 mg / day and clarithromycin 250 mg 2 times a day for 7 days also require evidence of large-scale randomized studies using relevant performance criteria and security [18] .
Several papers were devoted to the experience of clindamycin for the treatment of urogenital chlamydia during pregnancy. Efficacy and safety of this drug is comparable to amoxicillin. The use of clindamycin for the course of an initial therapy with the reception of azithromycin as a reserve drug has demonstrated a low level of untreated (4.2 cases per 1000 patients), but this strategy proved to be much more expensive compared to other combinations, and therefore less viable [10, 15].
Summary data on treatment of chlamydial infection in pregnant women are presented in a systematic Cochrane review includes 11 randomized controlled studies on the analysis of the comparative efficacy of erythromycin, amoxicillin and azithromycin in patients with chlamydial infection during pregnancy. Indicator of microbiological cure, indicating the elimination of the pathogen, and there is no risk of infant or mother, is about 90% for all the antibiotics (for placebo - 12%).
Drug of first choice is called erythromycin. Amoxicillin and azithromycin are very promising, showing greater clinical efficacy and lower incidence of adverse reactions in comparison with erythromycin, but the lack of long-term large-scale randomized trials of efficacy and safety of these drugs during pregnancy restricts their widespread introduction into routine clinical practice [7].
Priority area of pharmacotherapy of urogenital Chlamydia is now the determination of compliance with antibiotic exposure characteristics of the intracellular life cycle of chlamydia. It is noteworthy that buying amoxicillin is completing its life cycle, while in the vacuole of infected epithelial cells and the remaining, apparently, is not available to influence the majority of cellular and humoral defense mechanisms. It is not known whether antibiotics are capable of penetrating into the cells, kill chlamydia in vacuoles or their bactericidal activity is aimed at elementary bodies that are released under the natural death of infected cells. In particular, there is no doubt that, azithromycin and buy amoxicillin online penetrate into cells, particularly macrophages, and accumulate there in high concentrations. However, until now there is no conclusive evidence that these drugs have a more pronounced intracellular activity against chlamydia than other antibiotics or factors of immune protection. Pharmacokinetic studies in this area are particularly relevant to the question of latent chlamydial infection, which occurs in approximately 4-11% of pregnant women and requiring more intensive and prolonged treatment
