zithromax and Heart-Defects--Congenital

Topics: Academic Medical Centers; Adult; Aged; Azithromycin; Cohort Studies; COVID-19; Female; Genetic Diseases, Inborn; Heart Defects, Congenital; Hospitalization; Humans; Hydroxychloroquine; Intubation, Intratracheal; Male; New York City; Oxygen Inhalation Therapy; Retrospective Studies; Severity of Illness Index; Young Adult

Antibiotics are commonly prescribed during pregnancy. Although the safety of most penicillins is well established, some controversy and uncertainty are associated with the use of other commonly prescribed antibiotics.. To determine the risk of congenital malformations following first-trimester in utero exposure to 10 commonly prescribed antibiotics in Denmark.. This was a cohort study comprising all singleton liveborn children in Denmark between 2000 and 2015. Data on malformations were collected through 2016. Merging validated and comprehensive populationwide Danish healthcare and civic registries, we merged data on pregnancy, prescription drugs purchases during first trimester and congenital malformations. Using logistic regression, we calculated the odds ratio for congenital malformations (any), major congenital malformations, and cardiac congenital malformations for the 10 most commonly prescribed antibiotics (excluding 4 penicillins that served as control). In the primary analysis, the exposed cohort was compared to a cohort exposed to any of 4 penicillins considered safe during pregnancy (ampicillin, pivampicillin, benzylpenicillin, and phenoxymethylpenicillin). In sensitivity analysis, the exposed cohort was compared to an unexposed cohort. Covariate adjustments were made for maternal age at delivery, year of delivery, parity, pre-pregnancy body mass index, smoking, educational status, employment status, and annual personal income.. We found no increased risk of congenital malformations to be related to first-trimester in utero exposure to the 10 most commonly prescribed antibiotics in Denmark compared to a cohort of pregnant women exposed to penicillins that are considered safe during pregnancy. Compared to unexposed pregnancies, small increased risks for major malformations and cardiac malformations were apparent for pivmecillinam (odds ratio, 1.13; confidence interval, 1.06-1.19; and odds ratio, 1.15; confidence interval, 1.04-1.28, respectively), sulfamethizole (odds ratio, 1.15; confidence interval, 1.07-1.24; and odds ratio, 1.22; confidence interval, 1.07-1.39, respectively), and azithromycin (odds ratio, 1.19, confidence interval, 1.03-1.38; and odds ratio, 1.29, confidence interval, 0.99-1.67, respectively).. In this large populationwide cohort study, we found, with a high degree of precision, no increased risk of congenital malformations following first-trimester exposure to 10 commonly prescribed systemic antibiotics.

Topics: Adult; Amdinocillin Pivoxil; Anti-Bacterial Agents; Azithromycin; Case-Control Studies; Cohort Studies; Congenital Abnormalities; Denmark; Educational Status; Employment; Female; Heart Defects, Congenital; Humans; Logistic Models; Maternal Age; Maternal Exposure; Obesity, Maternal; Odds Ratio; Penicillins; Pregnancy; Pregnancy Trimester, First; Smoking; Sulfamethizole; Young Adult

Topics: American Heart Association; Anti-Bacterial Agents; Antibiotic Prophylaxis; Arrhythmias, Cardiac; Azithromycin; Heart Defects, Congenital; Humans; Risk Factors; Time Factors; United States; United States Food and Drug Administration

Macrolides have been linked to the occurrence of congenital heart defects, but findings are inconsistent. We therefore aimed to estimate the risk of major congenital malformations (MCMs) after fetal exposure to macrolides, focusing on cardiac malformations.. From the Quebec Pregnancy Cohort (1998-2008), women exposed to a macrolide or penicillin in the first trimester and unexposed women were studied. There were 135 859 pregnancies included; 914 were exposed to azithromycin, 734 to erythromycin, 686 to clarithromycin, and 9106 to penicillin during the first trimester. Cases of MCMs were identified within the first year of life.. After adjusting for potential confounders, azithromycin (RR = 1.19, 95%CI: 0.98, 1.44; 120 exposed cases), erythromycin (RR = 0.96, 95%CI: 0.74, 1.24; 66 exposed cases) and clarithromycin use (RR = 1.12, 95%CI: 0.99, 1.42; 79 exposed cases) during the first trimester of pregnancy were not statistically significantly associated with the risk of MCMs; no associations were observed for cardiac malformations.. First trimester exposure to any of the macrolides was not associated with an increased risk of overall MCMs or cardiac malformations specifically.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Clarithromycin; Cohort Studies; Erythromycin; Female; Heart Defects, Congenital; Humans; Infant, Newborn; Macrolides; Penicillins; Pregnancy; Pregnancy Trimester, First; Prenatal Exposure Delayed Effects; Quebec; Registries; Risk Factors

Prior studies have reported increased risks of congenital heart defects (CHD) and pyloric stenosis (PS) after prenatal exposure to macrolide antibiotics. We sought to assess the association between maternal use of erythromycin and nonerythromycin macrolides and the risks of CHD and PS.. Among participants in the Slone Epidemiology Center Birth Defects Study from 1994 through 2008, we identified 4132 infants with CHD and 735 with PS as cases, and 6952 infants without any malformation as controls. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) associated with use of erythromycin or nonerythromycin macrolides in each trimester using conditional logistic regression and adjusting for risk factors for CHD and PS, fever, specific types of infections, and their associated treatments.. During the first trimester, 0.4% and 0.7% of control women had used erythromycin and nonerythromycin macrolides, respectively. Compared to non-use during pregnancy, first-trimester exposure to erythromycin was not associated with an increased risk of CHD (OR, 1.3; 95% CI, 0.6-2.6) or PS (OR, 0.9; 95% CI, 0.3-3.0). The corresponding ORs for nonerythromycin macrolides were 0.7 (95% CI, 0.4-1.3) for CHD and 1.7 (95% CI, 0.6-4.6) for PS. We found no association between third-trimester exposure to erythromycin or nonerythromycin macrolides and the risk of PS. Hypothesis generation analyses did not identify appreciable associations between maternal use of macrolides and other common specific birth defects.. We found no meaningful associations between the risks of CHD, PS, and other common malformations in relation to use of macrolides in pregnancy.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Clarithromycin; Erythromycin; Female; Heart Defects, Congenital; Humans; Logistic Models; Macrolides; Pregnancy; Prenatal Exposure Delayed Effects; Pyloric Stenosis; Risk

Plastic bronchitis (PB) is a rare cause of obstructive airway disease in patients who have undergone partially corrective surgery for congenital heart disease (CHD). The etiology of plastic bronchitis in such patients is ill-defined, and treatment is ineffective. We report resolution of PB and severe obstructive airway disease after heart transplantation in a patient with CHD.

Topics: Anti-Bacterial Agents; Azithromycin; Bronchitis; Child; Cough; Female; Fontan Procedure; Heart Defects, Congenital; Heart Transplantation; Humans; Respiratory Function Tests; Sputum; Treatment Outcome