Azithromycin reduces frequency of premature death from Ureaplasma

Rose Marie Viscardi

Previous research suggests that nearly half of preterm infants younger than 32 weeks’ gestation are infected with Ureaplasma, a bacterium that is commonly found in the birth canal but is difficult to identify. Infection with Ureaplasma can lead to severe respiratory issues and can increase their likelihood of mortality. However, research presented at the European Respiratory Society International Congress suggests that azithromycin can effectively reduce the frequency of death in premature infants.

“Preterm infants who are at greatest risk for negative neonatal outcomes are those infants born before 27 weeks’ gestation, or 13 weeks before their expected due date, who have a lung infection with Ureaplasma bacteria and require a ventilator for breathing support,” Rose Marie Viscardi, MD, professor of pediatrics at the University of Maryland School of Medicine, told Infectious Diseases in Children. “This group of infants is at increased risk for death, bronchopulmonary dysplasia, chronic lung problems and more lung health problems in their first year of life.”

Viscardi and colleagues suspected that treating infants with azithromycin for Ureaplasma respiratory tract infection could reduce the rate of severe respiratory morbidity for these infants by the time they reach 1 year of age. The researchers conducted a prospective, multicenter, double-blind, placebo-controlled randomized clinical trial that included infants born at 24 to 28.6 weeks’ gestation. Patients received either IV azithromycin (20 mg/kg) or the same volume of a placebo.

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The researchers took tracheal and nasopharyngeal samples before and after dosing, which they tested for Ureaplasma using culture and PCR.

Of the 121 infants included in the trial, 36.3% tested positive for Ureaplasma. Infants who tested positive through tracheal samples were less likely to survive (71% vs. 90%) and were more likely to develop bronchopulmonary dysplasia (33% vs. 50%) than infants who tested negative through tracheal samples. Infants who provided nasopharyngeal samples also demonstrated higher rates of survival (71% vs. 100%) and higher rates of living without bronchopulmonary dysplasia (33% vs. 79%) compared with those who tested positive through tracheal samples.

According to the researchers, infants who were treated with azithromycin were less likely to die or have severe respiratory morbidity by 12 months’ adjusted age (33%) compared with those who tested positive for Ureaplasma but received a placebo (86%).

“Although the trial of 3-day treatment with azithromycin demonstrated that the antibiotic was effective in eliminating the Ureaplasma lung infection, there is insufficient data at this time to recommend routine testing and treatment in preterm infants,” Viscardi said. “A larger clinical trial is needed to determine the effectiveness of antibiotic treatment to improve survival and lung health.” – by Katherine Bortz

Reference:

Viscardi RM. Arch Dis Child Fetal Neonatal Ed. 2014;doi:10.1136/archdischild-2012-303351.

Viscardi RM, et al. Abstract OA301. Presented at: European Respiratory Society International Congress; Sept. 15-19, 2018; Paris, France.

Disclosures: Infectious Diseases in Children was unable to confirm relevant financial disclosures prior to publication.