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Azithromycin prophylaxis during a hospital outbreak of Mycoplasma pneumoniae pneumonia
T B Hyde1, M Gilbert, S B Schwartz
1Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Abstract:
Outbreaks of Mycoplasma pneumoniae (MP) in closed communities can have a high attack rate and can last several months. Azithromycin chemoprophylaxis has not been evaluated as a means of limiting transmission. This randomized, double-blinded placebo-controlled trial of azithromycin was conducted among asymptomatic hospital employees during an MP outbreak. Oropharyngeal swabs were obtained for detection of MP by polymerase chain reaction, and questionnaires were administered to assess clinical illness. Of the 147 employees who were enrolled, 73 received azithromycin and 74 received placebo. Carriage was similar within and between groups at weeks 1 and 6 (9.6% vs. 6.7% and 10.3% vs. 13.2%, respectively). Four episodes of clinically significant respiratory illness occurred in the azithromycin group versus 16 episodes in the placebo group (protective efficacy, 75%; 95% confidence interval, 28%-91%). Use of azithromycin prophylaxis in asymptomatic persons during an MP outbreak in a closed setting may be of value in reducing clinical illness.
Insights
Azithromycin prophylaxis may reduce clinical illness during Mycoplasma pneumoniae outbreaks. This study found a 75% reduction in respiratory illness in healthcare workers receiving azithromycin compared to placebo.
Area of Science:
- Infectious Diseases
- Respiratory Medicine
- Clinical Trials
Background:
- Mycoplasma pneumoniae (MP) outbreaks in closed communities are common and prolonged.
- Azithromycin chemoprophylaxis has not been previously studied for MP transmission control.
Purpose of the Study:
- To evaluate the efficacy of azithromycin chemoprophylaxis in preventing clinical illness during an MP outbreak.
- To assess the impact of azithromycin on MP transmission among asymptomatic hospital employees.
Main Methods:
- A randomized, double-blinded, placebo-controlled trial involving 147 asymptomatic hospital employees.
- MP detection via oropharyngeal swabs and polymerase chain reaction.
- Clinical illness assessment through questionnaires.
Main Results:
- Azithromycin prophylaxis demonstrated a 75% protective efficacy against clinically significant respiratory illness (95% CI, 28%-91%).
- MP carriage rates were similar between the azithromycin and placebo groups at weeks 1 and 6.
- Four respiratory illness episodes occurred in the azithromycin group versus 16 in the placebo group.
Conclusions:
- Azithromycin prophylaxis may be a valuable strategy for reducing clinical illness during MP outbreaks in closed settings.
- Prophylactic azithromycin appears effective in mitigating symptomatic MP infections without significantly altering carriage rates.