zithromax and Cerebral-Palsy

Bronchopulmonary dysplasia (BPD) is the most common chronic complication of extreme preterm birth. The authors applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to pharmacologic therapies found to prevent BPD. Caffeine and vitamin A are the only medications shown in high-quality studies to prevent BPD without the risk of clinically important adverse effects. Dexamethasone is effective for the prevention of BPD; but for many infants, the increased risks of hypertrophic cardiomyopathy, gastrointestinal perforation, and cerebral palsy outweigh this benefit. Several medications are currently under investigation for the prevention of BPD, but few are novel agents.

Topics: Anti-Bacterial Agents; Azithromycin; Bronchopulmonary Dysplasia; Caffeine; Cardiomyopathy, Hypertrophic; Central Nervous System Stimulants; Cerebral Palsy; Dexamethasone; Evidence-Based Medicine; Glucocorticoids; Humans; Infant, Newborn; Infant, Premature; Intestinal Perforation; Primary Prevention; Risk Assessment; Risk Factors; Vitamin A; Vitamins

Topics: Anti-Bacterial Agents; Azithromycin; Cerebral Palsy; Child; Chronic Disease; Humans; Male; Randomized Controlled Trials as Topic; Respiratory Tract Infections

A case of coagulopathy in a pre-adolescent with cerebral palsy that developed after chronic prophylactic antibiotic use is reported.. An 11-year-old boy with cerebral palsy was brought to the emergency department experiencing restlessness and decreased oxygen saturation. Evaluation of the patient revealed gallstone-related pancreatitis, with elevated serum amylase and lipase concentrations and abnormal liver function test results. At the time of the initial evaluation, the International Normalized Ratio (INR) was 6.54 (normal range, 0.8-1.2), and the activated partial thromboplastin time was 53.8 seconds (normal range, 24.4-34.8 seconds). The boy's medication history included use of azithromycin 200 mg every other day for about two years for antiinflammatory therapy. On confirmation of the elevated INR 2 hours after the initial evaluation, azithromycin was discontinued, and a single dose of phytonadione 2 mg was administered. About 14 hours after phytonadione administration, the INR had declined to 0.94; 43 hours later, the INR remained within the normal range without further phytonadione therapy. Using the probability scale of Naranjo and colleagues, this case was rated as a probable drug-related adverse event. Previous reports have linked the development of vitamin K deficiency and impaired coagulation to long-term antibiotic use, but not specifically to use of azithromycin or other macrolide antibiotics.. An elevated INR in a child with cerebral palsy was evidently related to long-term therapy with azithromycin. The abnormal INR normalized after discontinuation of azithromycin and administration of one dose of phytonadione.

Topics: Anti-Bacterial Agents; Antifibrinolytic Agents; Azithromycin; Blood Coagulation Disorders; Cerebral Palsy; Child; Humans; International Normalized Ratio; Male; Time Factors; Vitamin K 1; Vitamin K Deficiency