Clarithromycin in preventing bronchopulmonary dysplasia in Ureaplasma urealyticum-positive preterm infants

• Published in: Pediatrics (Evanston) Vol. 128; no. 6; p. e1496
• Main Authors: Ozdemir, Ramazan, Erdeve, Omer, Dizdar, Evrim Alyamac, Oguz, Serife Suna, Uras, Nurdan, Saygan, Sibel, Karabulut, Erdem, Dilmen, Ugur
• Format: Journal Article
• Language: English
• Published: United States 01.12.2011
• Subjects: Anti-Bacterial Agents - therapeutic use; Bronchopulmonary Dysplasia - etiology; Bronchopulmonary Dysplasia - prevention & control; Clarithromycin - therapeutic use; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - prevention & control; Male; Prospective Studies; Ureaplasma Infections - complications; Ureaplasma Infections - drug therapy; Ureaplasma urealyticum
• ISSN: 1098-4275
• DOI: 10.1542/peds.2011-1350

To evaluate the efficacy and safety of clarithromycin treatment in preventing bronchopulmonary dysplasia (BPD) in Ureaplasma urealyticum-positive preterm infants. Nasopharyngeal swabs for U urealyticum culture were taken from infants with a birth weight between 750 and 1250 g in the first 3 postnatal days. Infants with a positive culture for U urealyticum were randomly assigned to 1 of 2 groups to receive either intravenous clarithromycin or placebo. All the patients were followed at least up to the 36th postmenstrual week. A total of 224 infants met the eligibility criteria of the study. Seventy-four (33%) infants had a positive culture for U urealyticum in the first 3 day cultures. The rate of BPD development was significantly higher in patients with U urealyticum positivity (15.9% vs 36.4%; P < .01). However, multivariate logistic regression analysis failed to reveal a significant association between the presence of U urealyticum and BPD development (odds ratio: 2.4 [95% confidence interval: 0.9-6.3]; P = .06). Clarithromycin treatment resulted in eradication of U urealyticum in 68.5% of the patients. The incidence of BPD was significantly lower in the clarithromycin group than in the placebo group (2.9% vs 36.4%; P < .001). Multivariate logistic regression analysis confirmed the independent preventive effect of clarithromycin for the development of BPD (odds ratio: 27.2 [95% confidence interval: 2.5-296.1]; P = .007). Clarithromycin treatment prevents development of BPD in preterm infants who are born at 750 to 1250 g and colonized with U urealyticum.