Randomised trial of azithromycin to eradicate Ureaplasma in preterm infants

• Published in: Archives of disease in childhood. Fetal and neonatal edition Vol. 105; no. 6; pp. 615 - 622
• Main Authors: Viscardi, Rose Marie, Terrin, Michael L, Magder, Laurence S, Davis, Natalie L, Dulkerian, Susan J, Waites, Ken B, Ambalavanan, Namasivayam, Kaufman, David A, Donohue, Pamela, Tuttle, Deborah J, Weitkamp, Jorn-Hendrik, Hassan, Hazem E, Eddington, Natalie D
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.11.2020; BMJ Publishing Group
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - pharmacokinetics; Anti-Bacterial Agents - therapeutic use; Antibiotics; Azithromycin - administration & dosage; Azithromycin - pharmacokinetics; Azithromycin - therapeutic use; Bronchopulmonary Dysplasia - etiology; Clinical trials; Colonization; Double-Blind Method; Drug Administration Schedule; Drug dosages; Female; Gestational Age; Hospitals; Humans; Infant mortality; Infant, Extremely Premature; Infant, Newborn; Infant, Premature, Diseases - drug therapy; Infants; Intensive care; Intensive Care Units, Neonatal; Intention to Treat Analysis; Lung diseases; Male; Neonatal care; Neonates; Newborn babies; Original Research; Physiology; Premature babies; Premature birth; Prospective Studies; Respiratory tract; Respiratory Tract Infections - complications; Respiratory Tract Infections - drug therapy; Risk Factors; Statistical analysis; Ureaplasma Infections - complications; Ureaplasma Infections - drug therapy; Ventilators; United States > US; ureaplasma parvum; ureaplasma urealyticum; neonatology; prematurity; bronchopulmonary dysplasia
• ISSN: 1359-2998; 1468-2052
• DOI: 10.1136/archdischild-2019-318122

ObjectiveTo test whether azithromycin eradicates Ureaplasma from the respiratory tract in preterm infants.DesignProspective, phase IIb randomised, double-blind, placebo-controlled trial.SettingSeven level III–IV US, academic, neonatal intensive care units (NICUs).PatientsInfants 240–286 weeks’ gestation (stratified 240–266; 270–286 weeks) randomly assigned within 4 days following birth from July 2013 to August 2016.InterventionsIntravenous azithromycin 20 mg/kg or an equal volume of D5W (placebo) every 24 hours for 3 days.Main outcome measuresThe primary efficacy outcome was Ureaplasma-free survival. Secondary outcomes were all-cause mortality, Ureaplasma clearance, physiological bronchopulmonary dysplasia (BPD) at 36 weeks’ postmenstrual age, comorbidities of prematurity and duration of respiratory support.ResultsOne hundred and twenty-one randomised participants (azithromycin: n=60; placebo: n=61) were included in the intent-to-treat analysis (mean gestational age 26.2±1.4 weeks). Forty-four of 121 participants (36%) were Ureaplasma positive (azithromycin: n=19; placebo: n=25). Ureaplasma-free survival was 55/60 (92% (95% CI 82% to 97%)) for azithromycin compared with 37/61 (61% (95% CI 48% to 73%)) for placebo. Mortality was similar comparing the two treatment groups (5/60 (8%) vs 6/61 (10%)). Azithromycin effectively eradicated Ureaplasma in all azithromycin-assigned colonised infants, but 21/25 (84%) Ureaplasma-colonised participants receiving placebo were culture positive at one or more follow-up timepoints. Most of the neonatal mortality and morbidity was concentrated in 21 infants with lower respiratory tract Ureaplasma colonisation. In a subgroup analysis, physiological BPD-free survival was 5/10 (50%) (95% CI 19% to 81%) among azithromycin-assigned infants with lower respiratory tract Ureaplasma colonisation versus 2/11 (18%) (95% CI 2% to 52%) in placebo-treated infants.ConclusionA 3-day azithromycin regimen effectively eradicated respiratory tract Ureaplasma colonisation in this study.Trial registration number NCT01778634.