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Clarithromycin in preventing bronchopulmonary dysplasia in Ureaplasma urealyticum-positive preterm infants
Ramazan Ozdemir1, Omer Erdeve, Evrim Alyamac Dizdar
1Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey. ramazanoz@yahoo.com.tr
Insights
Clarithromycin effectively prevents bronchopulmonary dysplasia (BPD) in preterm infants colonized with Ureaplasma urealyticum. This antibiotic treatment significantly reduces BPD incidence in vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Respiratory Medicine
Background:
- Bronchopulmonary dysplasia (BPD) is a significant complication in preterm infants.
- Ureaplasma urealyticum colonization is associated with increased BPD risk.
- Effective preventative strategies for BPD are crucial for improving neonatal outcomes.
Purpose of the Study:
- To assess the efficacy and safety of clarithromycin in preventing BPD.
- To evaluate clarithromycin's impact on Ureaplasma urealyticum eradication in preterm infants.
- To determine if clarithromycin reduces BPD incidence in Ureaplasma urealyticum-positive neonates.
Main Methods:
- A randomized controlled trial involving preterm infants (750-1250 g birth weight) with positive Ureaplasma urealyticum nasopharyngeal cultures.
- Infants received either intravenous clarithromycin or a placebo.
- Outcomes including BPD development were assessed up to 36 postmenstrual weeks.
Main Results:
- Ureaplasma urealyticum positivity was linked to a higher BPD rate (36.4% vs 15.9%).
- Clarithromycin achieved Ureaplasma urealyticum eradication in 68.5% of treated infants.
- The BPD incidence was significantly lower in the clarithromycin group (2.9%) compared to placebo (36.4%).
Conclusions:
- Clarithromycin treatment is effective in preventing BPD development.
- The study highlights clarithromycin's independent preventive role against BPD in this high-risk infant population.
- This finding supports the use of clarithromycin for Ureaplasma urealyticum-positive preterm infants to reduce BPD.
Objective:
To evaluate the efficacy and safety of clarithromycin treatment in preventing bronchopulmonary dysplasia (BPD) in Ureaplasma urealyticum-positive preterm infants.
Patients And Methods:
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.
Results:
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).
Conclusions:
Clarithromycin treatment prevents development of BPD in preterm infants who are born at 750 to 1250 g and colonized with U urealyticum.
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