Erythromycin for chlamydiasis in pregnant women. Assessing adherence to a standard multiday, multidose course.

OBJECTIVE: To assess patient adherence among pregnant women infected with Chlamydia trachomatis given a self-administered, 10-day course of erythromycin prescribed as 500-mg tablets to be taken four times a day for the full 10-day period of treatment. STUDY DESIGN: Study participants (n = 30) were given the standard, 10-day supply of 500-mg tablets of erythromycin and instructed to take one tablet four times daily for 10 days. Patients were blinded to the fact that the Medication Event Monitoring System was being used and that their adherence to this course of drug therapy was being monitored. RESULTS: A 100% cure rate was achieved. The average percentage of therapeutic coverage actually achieved by the study participants declined with the length of erythromycin therapy. Further, as the duration of treatment increased, the longest interval between two successive doses of erythromycin also increased. CONCLUSION: This study demonstrated the importance of assessing both the quantitative and temporal aspects of self-administered oral medication when assessing patient adherence. Moreover, since the length of the course of antibiotic therapy was shown to affect patient adherence, coupled with the 100% cure rate we observed, future research geared toward maximizing adherence while minimizing duration of treatment seems warranted.

Single-dose azithromycin for Chlamydia in pregnant women.

OBJECTIVE: To assess the efficacy and occurrence of severe side effects associated with the use of a single dose of azithromycin in the treatment of Chlamydia trachomatis in pregnant women. STUDY DESIGN: Patients and their sexual partners were randomized into three treatment groups: both the patient and her sexual partner received a single dose of azithromycin (group 1); the patient was given a standard course of erythromycin, while her partner was given a standard course of tetracycline (group 2); and the patient was given a single dose of azithromycin with the sexual partner given a standard course of tetracycline (group 3). Group 3 was included in order to assess the relative efficacy of tetracycline with respect to the use of azithromycin among patients and to indirectly assess possible patient reinfection by sexual partners. RESULTS: With respect to the cure rate, 4.5% of study participants given azithromycin has positive cultures vs. 21.1% of patients given erythromycin or tetracycline (P = .018). With respect to side effects severe enough to warrant a change in medication, 7.4% of patients receiving azithromycin reported suffering such side effects vs. 38.8% of patients given erythromycin (P = .02). Among sexual partners, 28.6% given tetracycline reported severe side effects vs. none of those given azithromycin (P = .03). CONCLUSION: Azithromycin in the treatment of C trachomatis in pregnant women substantially improved the cure rates while substantially reducing the occurrence of severe side effects associated with the use of a standard course of erythromycin. Since both tetracycline and erythromycin are known to be effective against C trachomatis infection, the improved efficacy of azithromycin is probably due to noncompliance with the multidose, multiday regimen associated with the use of these two antibiotics.

The impact of prenatal exposure to cocaine on newborn costs and length of stay.

OBJECTIVE: Our intention is to determine newborn costs and lengths of stay attributable to prenatal exposure to cocaine and other illicit drugs. DATA SOURCES AND STUDY SETTING: All parturients who delivered at a large municipal hospital in New York City between November 18, 1991 and April 11, 1992. STUDY DESIGN: A cross-sectional analysis used multivariate, loglinear regressions to analyze differences in costs and length of stay between infants exposed and unexposed prenatally to cocaine and other illicit drugs, adjusting for maternal race, age, prenatal care, tobacco, parity, type of delivery, birth weight, prematurity, and newborn infection. DATA COLLECTION/EXTRACTION METHODS: Urine specimens, with linked obstetric sheets and discharge abstracts, provided information on exposure, prenatal behaviors, costs, length of stay, and discharge disposition. PRINCIPAL FINDINGS: Infants exposed to cocaine or some other illicit drug stay approximately seven days longer at a cost of $7,731 more than infants unexposed. Approximately 60 percent of these costs are indirect, the result of adverse birth outcomes and newborn infection. Hospital screening as recorded on discharge abstracts substantially underestimates prevalence at delivery, but overestimates its impact on costs.

The effect of recent cocaine use on the progress of labor.

OBJECTIVE: This study was undertaken to determine whether peripartum cocaine use shortens labor. STUDY DESIGN: A total of 1220 gravidas delivering at an urban county hospital (November 1991 through April 1992) had urine specimens sent for toxicology studies. Cervical dilatation on admission and time intervals during the course of labor were recorded. Analysis of covariance and exact tests for multiple contingency tables were used to compare duration of labor by cocaine use after we adjusted for other factors. RESULTS: Compared with nonusers, women who had positive test results for cocaine were older, were of greater parity, and were admitted to the hospital at greater cervical dilatation (4.63 cm vs 3.96 cm, p < 0.05). The duration of labor from admission to birth was also shorter (336 vs 565 minutes, p < 0.001). After we controlled for type of delivery, parity, birth weight, and prenatal care, there was no significant difference in labor duration in any stage. CONCLUSIONS: There is no difference in duration of any stage of labor related to cocaine use after patients' obstetric characteristics are controlled for.

Laparoscopic management of ovarian ectopic pregnancy.

Ovarian ectopic pregnancy is a rare entity. Traditional therapy has been laparotomy with oophorectomy and, more recently, with ovarian wedge resection. We report the first case that was diagnosed and treated laparoscopically and retrieved intact. Laparoscopic treatment of ovarian ectopic gestations appears to be a safe and conservative approach in selected patients.

The relationship between the ultrasonographic diagnosis of innocent amniotic band development and pregnancy outcomes.

OBJECTIVE: To determine the importance of amniotic bands diagnosed ultrasonographically and their relationship to pregnancy outcome. METHODS: We reviewed retrospectively the ultrasonographic records at State University of New York Health Science Center at Brooklyn and Kings County Hospital Center, identifying 25 cases of amniotic band diagnosed during 1986-1990. Cases were compared with 50 controls who had ultrasound evaluation at the same gestational age. Outcomes studied included fetal anomalies, obstetric factors or complications, pregnancy outcome, and maternal factors that may have predisposed to the formation of bands. RESULTS: All cases had unrestricted fetal movement on the index sonogram. No fetal abnormalities were observed in either the case or control series. The groups were not significantly different in terms of maternal risk factors, but significant differences were found for delivery at less than 37 weeks and birth weight less than 2500 g. CONCLUSION: Ultrasonographic diagnosis of an amniotic band in connection with sonographic findings of normal fetal anatomy may be a risk factor for preterm delivery and low birth weight. No association between amniotic band development and fetal anomalies was observed.