zithromax and Obesity

The aim of this manuscript is to outline an approach to severe asthma, which is among the most challenging problems faced by paediatric pulmonologists. A logical, protocolised approach is essential. The first step is to rule out alternative diagnoses. The next step is a multidisciplinary assessment. Severe, therapy resistant asthma (STRA) is rare, and most of those referred will improve if basic management is corrected, especially adherence to treatment. However some are unable or unwilling to make necessary changes (refractory asthma plus or refractory difficult asthma). Some, especially asthma in the obese, and those thought to have STRA, progress to bronchoscopic airway phenotyping and a parenteral steroid trial to determine an individualised treatment plan. Those with persistent eosinophilc airway inflammation should be considered for omalizumab, and mepolizumab. Pauci-inflammatory asthma remains a therapeutic challenge, with a paucity of evidence; increasing steroid therapy seems neither logical nor efficacious, but options include tiotropium and azithromycin. However the most important message to the paediatrician looking after a child with apprently severe asthma is that the answer is not uncritically escalating treatment, but finding the answer to the question, what is it about this child, and his/her environment, which means there is no response to what should be easily treated airway pathology? The answer usually requires input from a skilled and experienced multi-disciplinary team, without which management is unlikely to be succesful. CONCLUSION: When managing a child with severe asthma, a detailed multi-disciplinary is essential to get the basic management right, before prescribing biologicals.

Topics: Algorithms; Allergens; Anti-Asthmatic Agents; Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Asthma; Asthma, Exercise-Induced; Azithromycin; Bronchodilator Agents; Bronchoscopy; Child; Comorbidity; Environmental Exposure; Eosinophilia; Glucocorticoids; Humans; Medication Adherence; Obesity; Omalizumab; Patient Care Team; Severity of Illness Index; Smoking; Tiotropium Bromide; Tobacco Smoke Pollution

Manipulation of the intestinal microbiota has been linked to weight changes and obesity. To explore the influence of specific agents that alter the intestinal flora on weight in different patient groups we conducted a meta-analysis of randomized controlled trials (RCTs) reporting on the effects of probiotics, prebiotics, synbiotics, and antibiotics on weight. We searched the Pubmed and Cochrane Library databases for trials on adults, children, and infants evaluating the effects of these substances on weight. Our primary outcome was weight change from baseline. Standardized mean differences (SMDs) with 95% confidence intervals were calculated. We identified and included 13 adult, 17 children, and 23 infant RCTs. Effects were opposite among adults and children, showing weight loss among adults (SMD -0.54 [-0.83, -0.25)) and minor weight gains among children (SMD 0.20 [0.04, 0.36]) and infants (SMD 0.30 [-0.01, 0.62]) taking mainly Lactobacillus probiotic supplements. Heterogeneity was substantial in the adult and infant analyses and could not be explained by intervention or patient characteristics. Azithromycin administration in children with pulmonary disease was associated with weight gain (SMD 0.39 [0.24, 0.54]), without heterogeneity. A high risk of selective reporting and attrition bias was detected across the studies, making it difficult to draw firm conclusions. Overall, our meta-analysis suggests that there may be a role for probiotics in promoting weight loss in adults and weight gain in children, however additional studies are needed. Though we cannot recommend antibiotic administration for weight manipulation, its use provides advantageous weight gain in children with cystic fibrosis and bronchiectasis.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Bronchiectasis; Child; Child, Preschool; Gastrointestinal Microbiome; Humans; Infant; Lactobacillus; Lung Diseases; Meta-Analysis as Topic; Obesity; Placebo Effect; Prebiotics; Probiotics; Randomized Controlled Trials as Topic; Synbiotics; Weight Gain; Weight Loss

Women with obesity are at increased risk of complications during and after labor and delivery, including puerperal infection and cesarean delivery. As labor induction has become increasingly common, it is crucial to find ways to decrease complication rates in this high-risk population.. This study aimed to explore the effect of prophylactic antibiotics during labor induction of nulliparous women with obesity on the rates of cesarean delivery and puerperal infection and to estimate the parameters needed to calculate the sample size for a larger, multicenter trial.. From January 2019 to May 2021, 101 patients were randomized in the class III stratum (1 patient who was randomized ultimately did not undergo labor induction). From February 2020 to May 2021, 38 and 47 patients were randomized to class I and II strata, respectively (to assess the effect of obesity class on the outcomes expected to be influenced by antibiotic prophylaxis). In the antibiotics and placebo groups, the rates of cesarean delivery were 29.0% (95% confidence interval, 19.8-38.3) and 39.8% (95% confidence interval, 29.8-49.7), respectively, and puerperal infection occurred in 8.6% (95% confidence interval, 2.9-14.3) and 9.7% (95% confidence interval, 3.7-15.7), respectively. In the subgroup with class III obesity, in the antibiotics and placebo groups, the rates of cesarean delivery were 33.3% (95% confidence interval, 20.4-47.9) and 46.0% (95% confidence interval, 32.2-59.8), respectively, and puerperal infection occurred in 7.8% (95% confidence interval, 0.5-15.2) and 10.0% (95% confidence interval, 1.7-18.3), respectively. Note that this pilot study was not powered to detect differences of this magnitude but rather to estimate parameters.. The administration of prophylactic antibiotics during labor induction of nulliparous patients with obesity resulted in a 27% lower cesarean delivery rate overall and a 28% lower rate in patients with class III obesity. A larger trial is warranted to evaluate these differences.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Female; Humans; Infant, Newborn; Obesity; Pilot Projects; Pregnancy; Puerperal Infection

Obesity is associated with severe asthma, but no specific treatment has been established. The gut microbiome is increasingly recognized as a crucial factor, but specific treatments focused on the gut microbiome have not been established. Recently, azithromycin has been found to have the capacity to attenuate exacerbations, a characteristic of severe asthma. The effect of azithromycin on obesity-induced severe asthma is not understood.. The purpose of the present study is to clarify the effect of azithromycin on exacerbations in asthmatic patients with obesity. To explore the mechanism, the gut microbiome, metabolites of microbes such as short-chain fatty acids, and blood inflammatory cytokines will be analyzed to evaluate the correlation with the effect of azithromycin on exacerbations in obesity-induced severe asthma. A multi-center, prospective, single-arm intervention study is planned.. The present study will allow us to evaluate the effect of azithromycin on exacerbations, particularly in asthma patients with obesity, and explore biomarkers, targeting molecules including the gut microbiome, which are correlated with decreased exacerbations. The present results could contribute to identifying new therapeutic prospects and targeted microbes or molecules associated with severe clinical characteristics in asthmatic patients with obesity.. This study has been registered as a prospective study with the University Hospital Medical Information Network (UMIN0000484389) and the Japan Registry of Clinical Trials (jRCTs071220023).

Topics: Anti-Bacterial Agents; Asthma; Azithromycin; Double-Blind Method; Humans; Multicenter Studies as Topic; Obesity; Prospective Studies

Obesity, a metabolic disease caused by multiple factors, has become a global health problem. In addition to nutrient intake and sedentary lifestyle, environmental pollutants exposure has been shown to be involved in obesity epidemics. Antibiotics, a new type of environmental pollutant, have been widely used in animal husbandry, aquaculture and microorganism. However, the effects of antibiotics exposure on fat metabolism and metabolic diseases are largely unknown.

Topics: Adipose Tissue, Beige; Animals; Anti-Bacterial Agents; Azithromycin; Humans; Metabolic Diseases; Mice; Obesity; Rodentia

More than 17 million people in the US provide uncompensated care for adults with physical or cognitive limitations. Such caregiving is associated with worse mental and physical health, yet little research has investigated how publicly funded home care might ameliorate these harms.. To investigate the association between Medicaid home care services and family caregivers' health.. This longitudinal cohort study used data from the 1996 to 2017 Medical Expenditures Panel Survey. Data on all household members were collected in 5 interviews over 2 years. Person-level difference-in-difference models were used to isolate within-person changes associated with new onset of Medicaid home care. The Medical Expenditures Panel Survey longitudinal data sets included 331 202 individuals (approximately 10% excluded owing to loss to follow-up). Adult (age ≥21 years) members of households that contained at least 1 person with limited activities of daily living were included in our study. The analysis itself was performed from March to August of 2020.. New onset of regular (≥1 time per month) Medicaid home care in the household.. Self-rated mental and physical health (planned prior to beginning the study).. In this cohort study, Medicaid home care was associated with improvement in caregiver self-rated mental health, but not with any short-term change in self-rated physical health. When evaluating the social value of home care programs, policy makers should consider spillover benefits to caregivers.. For all treatment-naïve patients, TBR

Topics: Activities of Daily Living; Adult; Air Pollution, Indoor; Animals; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Antioxidants; Azithromycin; Canada; Carbon; Caregivers; Chlorine; Cohort Studies; Corn Oil; COVID-19 Drug Treatment; Daphnia; Dust; Ecosystem; Electrodes; Environmental Monitoring; Fatty Acids; Female; Flavonoids; Fluorides; Glycosides; Greece; Groundwater; Hippocampus; Home Care Services; Humans; Infant; Inflammation; Iridoids; Lamiaceae; Longitudinal Studies; Male; Medicaid; Memory; Metals, Heavy; Methanol; Mice; Microplastics; Middle Aged; N-Methylaspartate; Neural Networks, Computer; Nitrates; Nitrogen Oxides; Nylons; Obesity; Oleic Acid; Olive Oil; Oxidation-Reduction; Phosphorus; Place Cells; Plant Components, Aerial; Plant Extracts; Plastics; Polyesters; Polyurethanes; Prevalence; Quinic Acid; Reactive Oxygen Species; Receptors, N-Methyl-D-Aspartate; Risk Assessment; Sodium Chloride; Soil; Soil Pollutants; Stachys; Staphylococcus aureus; Stearic Acids; Superoxide Dismutase; U937 Cells; United States; Water; Water Pollutants, Chemical; Young Adult

Due to the wide spread of SARS-CoV2 around the world, the risk of death in individuals with metabolic comorbidities has dangerously increased. Mexico has a high number of infected individuals and deaths by COVID-19 as well as an important burden of metabolic diseases; nevertheless, reports about features of Mexican individuals with COVID-19 are scarce. The aim of this study was to evaluate demographic features, clinical characteristics and the pharmacological treatment of individuals who died by COVID-19 in the south of Mexico.. We performed an observational study including the information of 185 deceased individuals with confirmed diagnoses of COVID-19. Data were retrieved from medical records. Categorical data were expressed as proportions (%) and numerical data were expressed as mean ± standard deviation. Comorbidities and overlapping symptoms were plotted as Venn diagrams. Drug clusters were plotted as dendrograms.. The mean age was 59.53 years. There was a male predominance (60.1%). The mean hospital stay was 4.75 ± 4.43 days. The most frequent symptoms were dyspnea (88.77%), fever (71.42%) and dry cough (64.28%). Present comorbidities included diabetes (60.63%), hypertension (59.57%) and obesity (43.61%). The main drugs used for treating COVID-19 were azithromycin (60.6%), hydroxychloroquine (53.0%) and oseltamivir (27.3%).. Mexican individuals who died of COVID-19 had shorter hospital stays, higher frequency of shortness of breath, and higher prevalence of diabetes than individuals from other countries. Also, there was a high frequency of off-label use of drugs for their treatment.

Topics: Adult; Aged; Azithromycin; COVID-19; COVID-19 Drug Treatment; Diabetes Mellitus, Type 1; Female; Hospital Mortality; Hospitals; Humans; Hydroxychloroquine; Length of Stay; Male; Mexico; Middle Aged; Obesity; Oseltamivir; Retrospective Studies; SARS-CoV-2; Sex Factors

The study focuses on the effects of azithromycin on severity of ischemia/reperfusion myocardial injury during simulated systemic inflammatory response syndrome (SIRS) in primary visceral obesity (PVO). Total ischemia/reperfusion was modeled by Langendorff perfusion of isolated heart with following estimation of the size of myocardial infarction. SIRS was accompanied by an increase in blood levels of proinflammatory cytokines and LPS. Combination of PVO and SIRS produced no significant changes in the infarct size compared to the control. Administration of azithromycin to rats with PVO and SIRS resulted in pronounced alterations of biochemical and immunological parameters, although it did not affect the infarct size. In contrast, the use of tetracycline increased the size of myocardial infarction. This phenomenon should be taken into consideration in antimicrobial therapy.

Topics: Animals; Azithromycin; Cytokines; Lipopolysaccharides; Male; Myocardial Infarction; Myocardial Reperfusion Injury; Obesity; Obesity, Abdominal; Rats; Systemic Inflammatory Response Syndrome

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Age Factors; Angiotensin-Converting Enzyme Inhibitors; Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Antiviral Agents; Azithromycin; Bromhexine; Coronavirus Infections; COVID-19; Cytokines; Expectorants; Humans; Hydroxychloroquine; Hypertension; Inflammation; Interferon beta-1a; Interleukin-1; Interleukin-12; Interleukin-6; Lymphohistiocytosis, Hemophagocytic; Obesity; Pandemics; Pneumonia, Viral; Pulmonary Disease, Chronic Obstructive; Respiratory Distress Syndrome; Risk Factors; Smoking; Tumor Necrosis Factor-alpha

Topics: Adolescent; Adult; Asymptomatic Diseases; Azithromycin; Chloroquine; COVID-19; COVID-19 Drug Treatment; Democratic Republic of the Congo; Drug Combinations; Enoxaparin; Female; Hospital Mortality; Hospitalization; Hospitals; Humans; Intensive Care Units; Lopinavir; Male; Middle Aged; Obesity; Pandemics; Patient Discharge; Renal Insufficiency, Chronic; Retrospective Studies; Risk Factors; Ritonavir; SARS-CoV-2; Severity of Illness Index; Treatment Outcome

To examine whether co-administration of intestinal alkaline phosphatase (IAP) with antibiotics early in life may have a preventive role against metabolic syndrome (MetS) in mice.. A total of 50 mice were allocated to four treatment groups after weaning. Mice were treated with azithromycin (AZT) ± IAP, or with no AZT ± IAP, for three intermittent 7-day cycles. After the last treatment course, the mice were administered a regular chow diet for 5 weeks and subsequently a high-fat diet for 5 weeks. Body weight, food intake, water intake, serum lipids, glucose levels and liver lipids were compared. 16S rRNA gene pyrosequencing was used to determine the differences in microbiome composition.. Exposure to AZT early in life rendered mice susceptible to MetS in adulthood. Co-administration of IAP with AZT completely prevented this susceptibility by decreasing total body weight, serum lipids, glucose levels and liver lipids to the levels of control mice. These effects of IAP probably occur as a result of changes in the composition of specific bacterial taxa at the genus and species levels (e.g. members of Anaeroplasma and Parabacteroides).. Co-administration of IAP with AZT early in life prevents mice from susceptibility to the later development of MetS. This effect is associated with alterations in the composition of the gut microbiota. IAP may represent a novel treatment against MetS in humans.

Topics: Acholeplasma; Alkaline Phosphatase; Animals; Anti-Bacterial Agents; Azithromycin; Bacteroides; Cattle; Diet, High-Fat; Dietary Supplements; Dysbiosis; Feces; Gastrointestinal Microbiome; Intestinal Mucosa; Male; Metabolic Syndrome; Mice, Inbred C57BL; Molecular Typing; Obesity; Weaning; Weight Gain

The antibiotic azithromycin is a suggested alternative to erythromycin for treating patients with delayed gastric emptying. However, although hypothesized to activate motilin receptors, supportive evidence is unavailable. This was investigated using recombinant and naturally expressed motilin receptors in human stomach, comparing azithromycin with erythromycin.. [(125)I]-motilin binding and calcium flux experiments were conducted using human recombinant motilin receptors in CHO cells. Neuromuscular activities were studied using circular muscle of human gastric antrum, after electrical field stimulation (EFS) of intrinsic nerves.. Azithromycin (1-100 μM) and erythromycin (3-30 μM) concentration-dependently displaced [(125)I]-motilin binding to the motilin receptor (52 ± 7 and 58 ± 18% displacement at 100 and 30 μM respectively). Azithromycin, erythromycin and motilin concentration-dependently caused short-lived increases in intracellular [Ca(2+)] in cells expressing the motilin receptor. EC50 values were, respectively, 2.9, 0.92 and 0.036 μM (n = 3 each); and maximal activities were similar. In human stomach, EFS evoked cholinergically mediated contractions, attenuated by simultaneous nitrergic activation. Azithromycin and erythromycin lactobionate (30-300 μM each) facilitated these contractions (apparent E(max) values of 2007 ± 396 and 1924 ± 1375%, n = 3-4 each concentration, respectively). These actions were slow in onset and faded slowly. The higher concentrations also evoked short-lived muscle contraction. Contractions to a submaximally effective concentration of carbachol were unaffected by either drug.. Azithromcyin activates human recombinant motilin receptors in therapeutically relevant concentrations, similar to erythromycin. In humans, gastric antrum azithromycin caused long-lasting facilitation of cholinergic activity. These actions explain the gastric prokinetic activity of azithromycin.

Topics: Adult; Aged; Aged, 80 and over; Animals; Anti-Bacterial Agents; Azithromycin; Calcium; CHO Cells; Cricetulus; Electric Stimulation; Erythromycin; Female; Gastrointestinal Agents; Gastrointestinal Motility; Humans; Male; Middle Aged; Motilin; Obesity; Pyloric Antrum; Receptors, Gastrointestinal Hormone; Receptors, Neuropeptide; Recombinant Proteins

Epidemiological and pathological evidence links highly prevalent pathogens to chronic inflammatory diseases, such as type 2 diabetes. Animal models contribute critically to the mechanistic understanding of infectious enhancement of inflammatory diseases, which share insulin resistance as the central pathophysiological defect.. With use of a mouse model, we examined insulin resistance progression and the influence of infection (Chlamydia pneumoniae-infected vs. uninfected control mice), genetic background (C57BL/6 vs. A/J mice), dietary fat concentration (27% vs. 5%), and time (2, 5, 9, or 15 weeks after inoculation).. In obese C57BL/6 mice, C. pneumoniae infection induced significantly increased insulin resistance that persisted long after bacterial clearance. Circulating tumor necrosis factor (TNF)-alpha produced in response to acute C. pneumoniae lung colonization exacerbated insulin resistance but not TNF-alpha released in situ during secondary chlamydial infection. Azithromycin or anti-TNF-alpha antibody prevented infection-exacerbated insulin resistance but significantly enhanced chlamydial dissemination to the heart. Azithromycin-treated mice did not eliminate C. pneumoniae from lungs by 3 weeks after inoculation but had significantly lower loads (42 genomes per 100 mg) than did control mice (219 genomes per 100 mg) or anti-TNF-alpha antibody-treated mice (3090 genomes per 100 mg).. Murine C. pneumoniae infection enhanced insulin resistance development in a genetically and nutritionally restricted manner via circulating mediators. The relevance for the current human diabetes epidemic remains to be determined, but this finding is potentially important because of the high prevalence of human C. pneumoniae infection worldwide.

Topics: Acute Disease; Animals; Azithromycin; Chlamydophila Infections; Chlamydophila pneumoniae; Diabetes Mellitus, Type 2; Fatty Acids, Nonesterified; Insulin Resistance; Male; Mice; Mice, Inbred A; Mice, Inbred C57BL; Mice, Obese; Obesity; Pneumonia, Bacterial; Recurrence; Tumor Necrosis Factor-alpha