zithromax and Postoperative-Complications

The purpose of this article is to review the high-resolution CT characteristics of individual obstructive and restrictive chronic lung allograft dysfunction (CLAD) phenotypes to aid in making accurate diagnoses and guiding treatment.. Long-term survival and function after lung transplant are considerably worse compared with after other organ transplants. CLAD is implicated as a major limiting factor for long-term graft viability. Historically thought to be a single entity, bronchiolitis obliterans syndrome, CLAD is actually a heterogeneous group of disorders with distinct subtypes.

Topics: Anti-Bacterial Agents; Azithromycin; Bronchiolitis Obliterans; Graft Rejection; Humans; Lung Transplantation; Phenotype; Postoperative Complications; Respiratory Function Tests; Risk Factors; Syndrome; Tomography, X-Ray Computed; Transplantation, Homologous

Chronic lung allograft dysfunction (CLAD) was recently introduced as an overarching term mainly to classify patients with chronic rejection after lung transplantation, although other conditions may also qualify for CLAD. Initially, only the development of a persistent and obstructive pulmonary function defect, clinically identified as bronchiolitis obliterans syndrome (BOS), was considered as chronic rejection, if no other cause could be identified. It became clear in recent years that some patients do not qualify for this definition, although they developed a chronic and persistent decrease in FEV1 , without another identifiable cause. As the pulmonary function decline in these patients was rather restrictive, this was called restrictive allograft syndrome (RAS). In the present review, we will further elaborate on these two CLAD phenotypes, with specific attention to the diagnostic criteria, the role of pathology and imaging, the risk factors, outcome, and the possible treatment options.

Topics: Allografts; Azithromycin; Bronchiolitis Obliterans; Chronic Disease; Disease Progression; Forced Expiratory Volume; Fundoplication; Gastroesophageal Reflux; Graft Rejection; Humans; Lung Transplantation; Neutrophils; Phenotype; Postoperative Complications

Infective complications following induced abortions are still a common cause of morbidity and mortality. This review focusses on defining the strategies to improve care of women seeking an induced abortion and to reduce infective complications. We have considered the evidence for screening and cost-effectiveness for antibiotic prophylaxis. Current evidence suggests that treating all women with prophylactic antibiotics in preference to screening and treating is the most cost-effective way of reducing infective complications following induced abortions. The final strategy to prevent infective complications should be individualized for each region/area depending on the prevalence of organisms causing pelvic infections and the resources available.

Topics: Abortion, Induced; Adolescent; Adult; Antibiotic Prophylaxis; Azithromycin; Cost-Benefit Analysis; Doxycycline; Drug Therapy, Combination; Female; Humans; Metronidazole; Pelvic Inflammatory Disease; Postoperative Complications; Pregnancy; Sexually Transmitted Diseases, Bacterial; Young Adult

Delayed breast cellulitis is an infrequently reported entity after conservation therapy for breast cancer. We describe our experience with this entity at Naval Medical Center, San Diego.. Eight patients who presented with delayed cellulitis after wide local excision/axillary dissection and breast radiotherapy (RT) are presented. Their clinical characteristics and therapy are described and possible causative factors are analyzed.. The latency of breast cellulitis is variable after breast conservation therapy, although most cases in our experience and in the literature occur within a year post-RT. These infections are frequently refractory to a single course of antibiotics (n = 4 cases in our experience). Some patients suffer multiple episodes separated by months.. Breast cancer patients are at risk for delayed cellulitis after conservative surgery and RT. The mechanism of such events probably involves lymph stasis, however, therapy is no different from the more frequently occurring cases of cellulitis presenting perioperatively.

Topics: Aged; Amoxicillin; Azithromycin; Breast Diseases; Breast Neoplasms; Cellulitis; Clavulanic Acid; Combined Modality Therapy; Dicloxacillin; Drug Therapy, Combination; Female; Humans; Lymph Node Excision; Mastectomy, Segmental; Middle Aged; Postoperative Complications; Radiotherapy Dosage

Perioperative infections may be considered predictors of caesarean scar defect (CSD), and multidose antibiotics have a protective effect against CSD. However, the ability of adjunctive azithromycin combined with cephalosporin to reduce the prevalence of CSD remains unclear. The planned study aims to clarify the protective effect of antibiotics against CSD and to assess the effectiveness of adjunctive azithromycin prophylaxis for CSD.. This study is a double-blind, parallel-control randomised clinical trial that will be carried out at the International Peace Maternity and Child Health Hospital. A total of 220 eligible patients will be randomised (1:1) to receive either adjunctive azithromycin or single-dose cephalosporin 30 min before the incision. The evaluation criteria are the prevalence and characteristics of CSD as assessed by transvaginal ultrasound (TVU) and saline infusion sonohysterography (SIS) at 42 days, 6 months and 12 months after delivery. The primary outcome will be the prevalence of CSD, and the characteristics of CSD will be assessed by TVU and SIS 42 days after delivery; all other outcomes are secondary.. This protocol received authorisation from the Medical Research Ethics Committee of International Peace Maternity and Child Health Hospital on 25 April 2018 (approval no. GKLW2017-84). The findings will be reported in peer-reviewed publications and presentations at international scientific meetings.. ChiCTR-INR-17013272.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Cephalosporins; Cesarean Section; Cicatrix; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Postoperative Complications; Pregnancy; Pregnancy Complications, Infectious

Prophylactic azithromycin treatment has been demonstrated to improve freedom from bronchiolitis obliterans syndrome (BOS) 2 years after lung transplantation (LTx). In the current study, we re-evaluated the long-term effects of this prophylactic approach in view of the updated classification system for chronic lung allograft dysfunction (CLAD). A retrospective, intention-to-treat analysis of a randomized controlled trial comparing prophylactic treatment with placebo (n = 43) versus azithromycin (n = 40) after LTx was performed. Graft dysfunction (CLAD), graft loss (retransplantation, mortality), evolution of pulmonary function and functional exercise capacity were analyzed 7 years after inclusion of the last study subject. Following LTx, 22/43 (51%) patients of the placebo group and 11/40 (28%) patients of the azithromycin group ever developed CLAD (p = 0.043). CLAD-free survival was significantly longer in the azithromycin group (p = 0.024). No difference was present in proportion of obstructive versus restrictive CLAD between both groups. Graft loss was similar in both groups: 23/43 (53%) versus 16/40 (40%) patients (p = 0.27). Long-term pulmonary function and functional exercise capacity were significantly better in the azithromycin group (p < 0.05). Prophylactic azithromycin therapy reduces long-term CLAD prevalence and improves CLAD-free survival, pulmonary function, and functional exercise capacity after LTx.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Bacteremia; Bronchiolitis Obliterans; Cohort Studies; Double-Blind Method; Female; Follow-Up Studies; Forced Expiratory Volume; Graft Rejection; Graft Survival; Humans; Lung Transplantation; Male; Postoperative Complications; Prognosis; Risk Factors; Syndrome; Transplantation, Homologous

Postpartum infections are polymicrobial and typically include Ureaplasma, an intracellular microbe that is treated by macrolides such as azithromycin. The aim of this study was to evaluate the perinatal pharmacokinetics of azithromycin after a single preincision dose before cesarean delivery.. Thirty women who underwent scheduled cesarean delivery were assigned randomly to receive 500 mg of intravenous azithromycin that was initiated 15, 30, or 60 minutes before incision and infused over 1 hour. Serial maternal plasma samples were drawn from the end of infusion up to 8 hours after the infusion. Samples of amniotic fluid, umbilical cord blood, placenta, myometrium, and adipose tissue were collected intraoperatively. Breast milk samples were collected 12-48 hours after the infusion in 8 women who were breastfeeding. Azithromycin was quantified with high performance liquid chromatography separation coupled with tandem mass spectrometry detection. Plasma pharmacokinetic parameters were estimated with the use of noncompartmental analysis and compartmental modeling and simulations.. The maximum maternal plasma concentration was reached within 1 hour and exceeded the in vitro minimum inhibitory concentration (MIC50) of 250 ng/mL of Ureaplasma spp in all 30 patients. The concentrations were sustained with a half-life of 6.7 hours. The median concentration of azithromycin in adipose tissue was 102 ng/g, which was below the MIC50. The median concentration in myometrium was 402 ng/g, which exceeded the MIC50. Azithromycin was detectable in both the umbilical cord plasma and amniotic fluid after the single preoperative dose. Azithromycin concentrations in breast milk were high and were sustained up to 48 hours after the single dose. Simulations demonstrated accumulation in breast milk after multiple doses.. A single dose of azithromycin achieves effective plasma and tissue concentrations and is transported rapidly across the placenta. The tissue concentrations that are achieved in the myometrium exceed the MIC50 for Ureaplasma spp.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Cesarean Section; Female; Humans; Postoperative Complications; Pregnancy; Preoperative Care; Ureaplasma Infections; Young Adult

The results indicate that oral administration of azithromycin (AZM) is equivalent to intravenous administration of cefazolin (CEZ) for preventing surgical site infection (SSI) in patients undergoing tonsillectomy, and should be used as cost-effective antimicrobial prophylaxis.. Staphylococcus aureus, Streptococcus spp., and pharyngeal anaerobes have been described as major pathogens causing SSI in transpharyngeal operations such as tonsillectomy. The purpose of this study was to explore whether administration of AZM, an oral antimicrobial agent, might be equivalent to intravenous administration of a first-generation cefem antimicrobial agent for preventing SSI in patients undergoing tonsillectomy.. Patients undergoing tonsillectomy were divided into an AZM-treated group and a CEZ-treated group, for intergroup comparison of responses. AZM was administered once orally, 2 days before the operation, whereas patients in the CEZ-treated group received CEZ intravenously 30 min before the operation, 4 h postoperatively, and then twice daily for 3 consecutive days beginning the day after the operation.. There were no significant intergroup differences in mean duration of hospitalization after the operation, incidence of postoperative hemorrhage, postoperative analgesic effect, or hematologic/blood biochemical findings. The incidence of postoperative fever was significantly lower in the AZM-treated group. Diarrhea occurred as an adverse drug reaction in the AZM-treated group, but no clinically significant adverse reactions were noted.

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Cefazolin; Delayed-Action Preparations; Diarrhea; Female; Fever; Humans; Infusions, Intravenous; Male; Postoperative Complications; Surgical Wound Infection; Tonsillectomy

Trichiasis recurrence following surgery is a serious problem for trachoma programs.. To determine if postoperative treatment with azithromycin compared with topical tetracycline reduces recurrence up to 1 year, and if azithromycin treatment of household members provides additional benefit compared with treating only the surgical patient.. A randomized, single-masked, clinical trial was conducted in Ethiopia. A total of 1452 patients with trichiasis were randomized 1:1:1 to the following 3 arms: single-dose (1 g) oral azithromycin alone, single-dose azithromycin for household members (20 mg/kg up to 1 g) plus the patient, or topical tetracycline (twice per day for 6 weeks).. Trichiasis recurrence within 1 year following surgery.. The combined azithromycin groups had significantly fewer recurrences, 6.9 of 100 person-years overall, compared with topical tetracycline, 10.3 of 100 person-years (P = .047). There was no additional reduction in the arm that also treated household members, 8.1 of 100 person-years, compared with treating the surgical patients alone, 5.8 of 100 person-years (P = .19).. In trachoma-endemic areas, a single dose of azithromycin reduced postoperative trichiasis recurrence rates by one third compared with topical tetracycline. Application to Clinical Practice In countries where azithromycin is part of the Trachoma Control Program, patients with trachomatous trichiasis should be treated postoperatively to prevent recurrence.

Topics: Administration, Oral; Anti-Bacterial Agents; Azithromycin; Ethiopia; Eyelashes; Eyelid Diseases; Female; Hair Diseases; Humans; Male; Middle Aged; Postoperative Complications; Secondary Prevention; Single-Blind Method; Tetracycline

Combined treatments with non-steroidal anti-inflammatory drugs and antibiotics may offer significant benefits in the prevention of pain and infections associated with oral surgery. In this study, piroxicam and azithromycin were administered to patients undergoing dental extraction to examine the efficacy of piroxicam in the prevention of post-operative pain and inflammatory complications, either in the absence or in the presence of a concomitant antibiotic treatment. Thirty patients were randomly assigned to three groups and treated for 3 days, before impacted lower third molar removal, as follows: (1) sublingual piroxicam-FDDF (fast dissolving dosage formulation) 20 mg/day; (2) oral azithromycin 500 mg/day; (3) piroxicam-FDDF 20 mg/day plus azithromycin 500 mg/day. Oral acetaminophen (500 mg tablets) was allowed as rescue analgesic medication. Pain intensity was evaluated on a 100-mm visual-analogue scale after dental extraction (day 1), and at days 2, 3, 7 after surgery. Edema and trismus were estimated at days 2 and 7. At days 1 and 2, pain intensity was significantly lower in patients treated with piroxicam-FDDF, either alone (p < 0.05) or in combination with azithromycin (p < 0.05), than in patients administered with azithromycin alone. A higher acetaminophen consumption was also recorded in the latter group (p < 0.01). Pain intensity values did not differ among treatment groups at days 3 and 7. At day 2, the facial edema was significantly less intense in patients exposed to piroxicam-FDDF alone, as compared to patients treated with azithromycin, either alone (p < 0.05) or in combination with piroxicam-FDDF (p < 0.05). No significant differences were detected when comparing groups for trismus at days 2 and 7. The present results indicate that, when given alone in the pre-operative period, piroxicam-FDDF effectively counteracts post-surgical pain and inflammatory reactions in oral tissues. Upon combined treatment with piroxicam-FDDF and azithromycin, the macrolide antibiotic may reduce the influence of piroxicam on post-operative inflammation, without affecting its beneficial effect on surgical pain.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Azithromycin; Drug Therapy, Combination; Edema; Female; Humans; Male; Molar, Third; Pain, Postoperative; Piroxicam; Postoperative Complications; Tooth Extraction; Tooth, Impacted; Trismus

Short-term improvement in lung function was observed in 5 of 6 lung transplant recipients with bronchiolitis obliterans syndrome (BOS) who were treated with oral azithromycin. We assessed the long-term effect (mean duration 10 months) of treatment with oral azithromycin in 11 lung transplant recipients with BOS. Mean forced expiratory volume in 1 second (FEV1) was 40 +/- 9% at initiation of azithromycin treatment, 39 +/- 10% after 1 month, 39 +/- 12% after 4 months, 38 +/- 10% after 7 months and 38 +/- 10% after 10 months, respectively (statistically non-significant for all data). We conclude that long-term administration with oral azithromycin does not reverse BOS in lung transplant recipients, but may slow progression of the disease.

Topics: Administration, Oral; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Bronchiolitis Obliterans; Disease Progression; Drug Administration Schedule; Female; Follow-Up Studies; Forced Expiratory Volume; Humans; Lung; Lung Transplantation; Male; Middle Aged; Pilot Projects; Postoperative Complications; Treatment Outcome

Bronchiolitis obliterans syndrome (BOS) is the leading cause of late mortality after lung transplantation.. We added azithromycin (AZI) (250 mg/day for 5 days, followed by 250 mg every other day) to the current immunosuppressive therapy in eight lung transplant recipients (mean age 36 years) with established BOS in an attempt to prevent further decline of the forced expiratory volume in 1 sec (FEV1).. Before the administration of AZI, there was a gradual decline of the FEV1 (-34.4%+/-14.7%) compared with the patients' best postoperative values. Twelve weeks after AZI had been added, there was a significant increase in the FEV1 (+18.3%+/-14.6%, P <0.0001, analysis of variance) with an absolute increase of 328+/-305 mL. This increase persisted in three patients during 9 months of follow-up.. AZI is a promising drug for some patients with BOS after lung transplantation. The exact mechanism of action is unknown at the present time.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Bronchiolitis Obliterans; Child; Child, Preschool; Forced Expiratory Volume; Humans; Lung Transplantation; Middle Aged; Postoperative Complications; Treatment Outcome

Topics: Anti-Bacterial Agents; Area Under Curve; Azithromycin; Creatinine; Cyclosporine; Follow-Up Studies; Gingival Hyperplasia; Humans; Immunosuppressive Agents; Kidney Transplantation; Postoperative Complications; Recurrence; Time Factors; Treatment Outcome

To evaluate maternal postoperative infections before and after addition of adjunctive azithromycin to standard antibiotic prophylaxis for prelabor cesarean births.. We conducted a retrospective cohort study of patients with singleton gestations at more than 23 weeks of gestation who underwent prelabor cesarean birth at a single tertiary care center. Deliveries were categorized as those before implementation of 500 mg intravenous azithromycin in addition to standard preoperative cephalosporin antibiotic prophylaxis (pre-AZI group; January 2013-September 2015) and those after implementation of adjunctive azithromycin (post-AZI group; January 2016-December 2018). Cesarean births from October to December 2015 were excluded as a washout period. The primary outcome was a composite of postcesarean infections (endometritis, superficial or deep wound infections, intra-abdominal abscess, urinary tract infections). Secondary outcomes included composite components, other wound or postoperative complications, and select neonatal morbidities. Outcomes were compared between groups, and adjusted odds ratios (aORs) and 95% CIs were calculated using multivariable analysis. Propensity score matching was performed to assess the robustness our analysis.. Of 2,867 delivering patients included for analysis, 1,391 (48.5%) were in the pre-AZI group and 1,476 (51.5%) were in the post-AZI group. Patients in the post-AZI group were older and were more likely to have private insurance, use aspirin, and receive predelivery antibiotics within 2 weeks. There were significantly lower odds of composite infection after azithromycin implementation (3.3% vs 4.8%, aOR 0.60, 95% CI 0.40-0.89), driven by a reduction in wound infection odds (2.4% vs 3.5%, aOR 0.61, 95% CI 0.39-0.98). There were lower odds of other postpartum complications, including wound seroma (0.5% vs 0.9%, aOR 0.34, 95% CI 0.13-0.90) and dehiscence (0.5% vs 1.2%, aOR 0.32, 95% CI 0.13-0.79). There were no differences in select neonatal morbidities between groups. Of 1,138 matching sets in the propensity analysis, the primary outcome remained significantly lower in the post-AZI group (aOR 0.64, 95% CI 0.41-0.99).. Adopting adjunctive azithromycin for prelabor cesarean deliveries was associated with lower odds of postpartum infection.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Cesarean Section; Female; Humans; Infant, Newborn; Postoperative Complications; Pregnancy; Retrospective Studies; Surgical Wound Infection

Chronic lung allograft dysfunction (CLAD) is the most important long-term complication after lung transplant (LTx), and clinical experience suggests significant variability in its management. We sought to capture azithromycin practices among LTx providers internationally. A survey was distributed via the International Society for Heart and Lung Transplantation and completed by 103 respondents (15 countries). Azithromycin indications, timing, and dosing varied significantly, and 37 (36%) reported inconsistency even within their center. Thirty (29%) reported initiating azithromycin prophylactically (during initial transplant hospitalization). Of 73 others, only 10 (14%) reported waiting until CLAD diagnosis (with persistent ≥20% pulmonary function decline). Most initiated azithromycin after a CLAD risk-factor and/or event, including 59 (81%) for a persistent ≥10% decrement in FEV

Topics: Azithromycin; Drug Prescriptions; Health Care Surveys; Humans; Internationality; Lung Transplantation; Postoperative Complications; Practice Patterns, Physicians'

Over the last several decades, the field of lung transplantation has made significant advances. Despite these advancements, morbidity and mortality rates are still high when compared to other solid organ transplants. Clinical trials have a significant role bringing new medications with better effects than their predecessors. Our study is critical in evaluating and tracking clinical trials involving rejection of lung transplant, with a focus on interventional therapeutic trials.. On November 3, 2021, we searched clinicaltrial.gov for interventional clinical trials related to lung transplant rejection. A total of 39 clinical trials are included in this study. Characteristics on each trial were gathered. Linked publications were searched using Medline/PubMed and Embase/Scopus, and their content reviewed and summarized.. The majority of trials were divided into completed (15 out of 39) and recruiting (12 out of 39). 17 trials had between 11 and 50 participants, and 8 had above 100. Only 1 trial lasted >10 years, and the average length of all trials was 3.6 years. The majority of trials were conducted in Europe/UK/Russia and the United States/Canada (17 and 18 trials, respectively). The results were provided in 3 trials, and also published in 3, showing a decrease in the rate of patients reaching an endpoint after chronic rejection with liposomal aerosol cyclosporine, a decrease in their cytokines level, and an increase in their 5-year-survival rate compared to the oral conventional immunosuppressant, the benefit of sirolimus in decreasing the acute rejection rate and severity in comparison to azathioprine, and its efficacy against cytomegalovirus infections. Other trials revealed the benefits of azithromycin in remarkably decreasing airways and systemic inflammation, with a concomitant decline in the risk of both BOS and CLAD; highlighting the deleterious effects of air pollution after transplantation surgery; and using the grading biopsy as a post-transplantation assessment tool.. This study is a descriptive analysis of clinical trials targeting lung transplant rejection. This study shows the low number of trials, lack of variety in location and low publishing rates. Although focus of published trials was mainly towards azithromycin, bronchiolitis obliterans syndrome, air pollution, and biopsy in grading, a remarkable progress was realized concerning therapies, leading to less complications with a delay of chronic rejection onset, and an increase in overall survival. This sheds the light on the need for managing research efforts to fulfill any lack in specific domain, leading to new, effective therapies, and providing thereby much more benefit.

Topics: Azithromycin; Bronchiolitis Obliterans; Clinical Trials as Topic; Graft Rejection; Humans; Immunosuppressive Agents; Lung; Lung Transplantation; Postoperative Complications

We herein report the case of a 20 year-old-man who developed bronchiolitis obliterans after living-donor renal transplantation. The patient presented with dyspnea on exertion and wheezing two years after renal transplantation, and spirometry showed an obstructive pattern. Surgical lung biopsy revealed subepithelial fibrosis that constricted and obstructed the intrabronchiolar space. Based on these findings, the patient was diagnosed with bronchiolitis obliterans. He was prescribed bronchodilators and azithromycin, and he achieved stable respiratory function for two years. The differential diagnosis of respiratory symptoms after renal transplantation includes opportunistic infection and drug-induced lung injury; however, bronchiolitis obliterans should also be considered.

Topics: Adult; Azithromycin; Bronchiolitis Obliterans; Bronchodilator Agents; Diagnosis, Differential; Fibrosis; Humans; Kidney Transplantation; Living Donors; Lung; Male; Postoperative Complications; Spirometry; Young Adult

Malakoplakia is a chronic granulomatous disease associated with incomplete clearance of bacterial pathogens. A multimodal approach to therapy includes antimicrobials with intracellular activity, reduction in immunosuppression, and debulking of lesions. Azithromycin has an intracellular mechanism of action and enhanced Gram-negative activity compared to other macrolides. Despite some in vitro data to support its use, there are no clinical breakpoints or epidemiological cut-off values for most Enterobacterales from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) or the Clinical and Laboratory Standards Institute (CLSI). We present two cases, previously unreported, of Escherichia coli associated renal allograft malakoplakia successfully treated with azithromycin.

Topics: Allografts; Anti-Bacterial Agents; Azithromycin; Escherichia coli; Escherichia coli Infections; Female; Humans; Kidney Transplantation; Malacoplakia; Microbial Sensitivity Tests; Middle Aged; Postoperative Complications

The aim of this study was to evaluate the clinical course of COVID-19 in patients who had recently undergone a cardiac procedure and were inpatients in a cardiac rehabilitation department.. All patients hospitalized from 1 February to 15 March 2020 were included in the study (n = 35; 16 men; mean age 78 years). The overall population was divided into two groups: group 1 included 10 patients who presented with a clinical picture of COVID-19 infection and were isolated, and group 2 included 25 patients who were COVID-19-negative. In group 1, nine patients were on chronic oral anticoagulant therapy and one patient was on acetylsalicylic acid (ASA) and clopidogrel. A chest computed tomography scan revealed interstitial pneumonia in all 10 patients.. During hospitalization, COVID-19 patients received azithromycin and hydroxychloroquine in addition to their ongoing therapy. Only the patient on ASA with clopidogrel therapy was transferred to the ICU for mechanical ventilation because of worsening respiratory failure, and subsequently died from cardiorespiratory arrest. All other patients on chronic anticoagulant therapy recovered and were discharged.. Our study suggests that COVID-19 patients on chronic anticoagulant therapy may have a more favorable and less complicated clinical course. Further prospective studies are warranted to confirm this preliminary observation.

Topics: Aged; Anti-Infective Agents; Anticoagulants; Azithromycin; Cardiac Surgical Procedures; Combined Modality Therapy; Coronavirus Infections; COVID-19; Female; Humans; Hydroxychloroquine; Male; Outcome and Process Assessment, Health Care; Pandemics; Platelet Aggregation Inhibitors; Pneumonia, Viral; Postoperative Complications; Tomography, X-Ray Computed

Adding azithromycin to standard antibiotic prophylaxis for unscheduled cesarean delivery has been shown to reduce postcesarean infections. Because wound infection with ureaplasmas may not be overtly purulent, we assessed the hypothesis that azithromycin-based extended-spectrum antibiotic prophylaxis also reduces wound complications that are identified as noninfectious.. This is a secondary analysis of the C/SOAP (Cesarean Section Optimal Antibiotic Prophylaxis) randomized controlled trial, which enrolled women with singleton pregnancies ≥24 weeks who were undergoing nonelective cesarean. Women were randomized to adjunctive azithromycin or identical placebo up to 1 hour preincision. All wound complications occurring within 6 weeks were adjudicated into infection and noninfectious wound complications (seroma, hematoma, local cellulitis, and other noninfectious wound breakdown). The primary outcome for this analysis is the composite of noninfectious wound complications.. While adding azithromycin to usual antibiotic prophylaxis for nonelective cesarean delivery does reduce the risk of postcesarean infections, it did not significantly reduce the risk of postcesarean noninfectious wound complications.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Cellulitis; Cesarean Section; Female; Hematoma; Humans; Postoperative Complications; Pregnancy; Risk; Seroma; Surgical Wound Infection

Postoperative infections remain a serious concern after cesarean delivery, the most common major surgical procedure in the United States. Multiple strategies have been proposed to combat this problem, including the addition of azithromycin to the standard preoperative antibiotic prophylaxis. However, as obstetricians, we have failed to uniformly adopt precesarean vaginal preparation despite convincing evidence from randomized controlled trials that this technique reduces postoperative rates of endometritis by more than 50%. This reduction is similar to that seen with the addition of azithromycin. Vaginal preparation with povidone-iodine solution may target the same genital pathogens as azithromycin, which are commonly implicated in endometritis, a polymicrobial infection that may be under-addressed by our current antiseptic techniques. A recent review of maternal-fetal medicine fellows' practices at the time of cesarean delivery and recent publications on precesarean vaginal cleansing suggest that this practice has not yet gained hold in the United States.

Topics: Anti-Infective Agents, Local; Antibiotic Prophylaxis; Azithromycin; Cesarean Section; Endometritis; Female; Humans; Obstetrics; Postoperative Complications; Povidone-Iodine; Pregnancy; Preoperative Care; Standard of Care; Surgical Wound Infection; Vagina

Although topical antibiotics have been used as antimicrobial prophylaxis after ocular surgery, recent studies have determined that intracameral cefuroxime at the end of surgery significantly reduce the risk to suffer an infection and suggest that the use of topical antibiotics in the prophylaxis of infectious postoperative endophthalmitis (IPOE) is controversial. Moreover, there is no evidence to confirm the higher effectiveness of topical ciprofloxacin, considered the standard of care, or topical azithromycin in preventing IPOE of cataract surgeries.. IPOE topical prophylaxis was performed with two different strategies: with azithromycin from January 1st, 2010 to December 31st, 2014 (group I) and with ciprofloxacin from January 1st, 2015 to January 31st, 2017 (group II). Patient characteristics and clinical signs and symptoms of IPOE from all consecutive cataract surgeries performed over a 7-year period were collected.. A total of 15,146 cataract surgeries were conducted; 10,756 in group I and 4,390 in group II. Two cases of IPOE in each group were diagnosed, showing a 0.019% and 0.046% rate respectively, with no statistically significance. IPOE cases were related with aging, systemic and ocular comorbidities or with a complicated cataract surgery.. The benefit of the application of topical antibiotics after cataract surgery is questionable when intracameral cefuroxime prophylaxis is performed and no better effectiveness with ciprofloxacin or azithromycin was observed.

Topics: Administration, Topical; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Cataract Extraction; Cefuroxime; Ciprofloxacin; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Male; Ophthalmic Solutions; Postoperative Complications

To investigate the cost-effectiveness of adding azithromycin to standard cephalosporin regimens of cesarean delivery prophylaxis by considering the maternal outcomes in the current and potential subsequent pregnancies.. A cost-effectiveness model was created using TreeAge to compare the outcomes of using azithromycin-cephalosporin with cephalosporin alone in a theoretical cohort of 700,000 women, the approximate number of nonelective cesarean deliveries annually in the United States that occur during labor or after membrane rupture. Outcomes examined included endometritis, wound infection, sepsis, venous thromboembolism, and maternal death in the current pregnancy and uterine rupture, cesarean hysterectomy, and maternal death in subsequent pregnancies, including cost and quality-adjusted life-years for both pregnancies. Probabilities, utilities, and costs were derived from the literature, and a cost-effectiveness threshold was set at $100,000 per quality-adjusted life-year. Sensitivity analyses were used to determine the robustness of our results.. Compared with cephalosporin alone for prophylaxis, our model showed 16,100 fewer cases of endometritis, 17 fewer cases of sepsis, eight fewer cases of venous thromboembolism, and one fewer maternal death with azithromycin-cephalosporin. Additionally, this strategy prevented 36 uterine ruptures and four cesarean hysterectomies in the subsequent pregnancy. Overall, the addition of azithromycin led to both lower costs and higher quality-adjusted life-years when compared with standard cephalosporin prophylaxis. In sensitivity analysis, we found that as long as the cost of azithromycin remained below $930 (baseline cost $27), it was cost-effective.. For women who undergo cesarean delivery in labor or after membrane rupture, compared with cephalosporin alone, the addition of azithromycin to cesarean delivery infection prophylaxis is less costly and leads to better maternal outcomes in the index delivery and subsequent deliveries. These findings support the use of prophylactic azithromycin at the time of cesarean delivery.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Cephalosporins; Cesarean Section; Cost-Benefit Analysis; Endometritis; Female; Humans; Maternal Mortality; Models, Economic; Postoperative Complications; Pregnancy; Sepsis; Surgical Wound Infection

The natural history of lung function in patients with bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic cell transplant is poorly characterized. Understanding the trajectory of lung function is necessary for prompt clinical recognition and treatment and also for the rational design of prospective studies.. To describe the longitudinal trajectory of lung function parameters, including FEV. Subjects with BOS defined by National Institutes of Health consensus guidelines criteria from a recent multicenter prospective trial of combination treatment with fluticasone, azithromycin and montelukast and a retrospective cohort from Fred Hutchinson Cancer Research Center were included. Longitudinal change in FEV. The FEV

Topics: Acetates; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Azithromycin; Bronchiolitis Obliterans; Cyclopropanes; Drug Therapy, Combination; Female; Fluticasone; Forced Expiratory Volume; Hematopoietic Stem Cell Transplantation; Humans; Kaplan-Meier Estimate; Linear Models; Lung; Male; Middle Aged; Multivariate Analysis; Postoperative Complications; Prospective Studies; Quinolines; Retrospective Studies; Sulfides; Survival Rate; United States; Young Adult

Topics: Anti-Bacterial Agents; Asthma; Azithromycin; Child, Preschool; Humans; Male; Postoperative Complications; Radiography, Thoracic; Subcutaneous Emphysema; Treatment Outcome

Lymphocytic airway inflammation is a major risk factor for chronic lung allograft dysfunction, for which there is no established treatment. We investigated whether azithromycin could control lymphocytic airway inflammation and improve allograft function. Fifteen lung transplant recipients demonstrating acute allograft dysfunction due to isolated lymphocytic airway inflammation were prospectively treated with azithromycin for at least 6 months (NCT01109160). Spirometry (FVC, FEV1 , FEF25-75 , Tiffeneau index) and FeNO were assessed before and up to 12 months after initiation of azithromycin. Radiologic features, local inflammation assessed on airway biopsy (rejection score, IL-17(+)  cells/mm(2) lamina propria) and broncho-alveolar lavage fluid (total and differential cell counts, chemokine and cytokine levels); as well as systemic C-reactive protein levels were compared between baseline and after 3 months of treatment. Airflow improved and FeNO decreased to baseline levels after 1 month of azithromycin and were sustained thereafter. After 3 months of treatment, radiologic abnormalities, submucosal cellular inflammation, lavage protein levels of IL-1β, IL-8/CXCL-8, IP-10/CXCL-10, RANTES/CCL5, MIP1-α/CCL3, MIP-1β/CCL4, Eotaxin, PDGF-BB, total cell count, neutrophils and eosinophils, as well as plasma C-reactive protein levels all significantly decreased compared to baseline (p < 0.05). Administration of azithromycin was associated with suppression of posttransplant lymphocytic airway inflammation and clinical improvement in lung allograft function.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Bronchitis; Bronchoalveolar Lavage; C-Reactive Protein; Cytokines; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Lung Diseases; Lung Transplantation; Lymphocytes; Male; Middle Aged; Pneumonia; Postoperative Complications; Prognosis; Prospective Studies; Respiratory Function Tests; Retrospective Studies; Spirometry; Transplantation, Homologous; Young Adult

Topics: Azithromycin; Bronchitis; Female; Graft Rejection; Humans; Lung Transplantation; Lymphocytes; Male; Pneumonia; Postoperative Complications

Interleukin-17 (IL-17) is involved in autoimmune and chronic pulmonary diseases and linked with neutrophilic inflammation. Azithromycin reduces and prevents broncholaveolar lavage (BAL) neutrophilia after lung transplantation (LTx). In this investigation we assessed the involvement of IL-17 in different post-transplant complications in human LTx biopsies.. Immunohistochemical staining against IL-17A was performed on biopsies of LTx patients with either chronic rejection, acute A-grade rejection (A > 2B0), lymphocytic bronchiolitis (LB), infection, and stable patients. Biopsies of 7 patients with LB were stained before and after azithromycin treatment. IL-17+ cells were quantified as number per square millimeter of lamina propria. Double staining with CD4/CD8 was performed to determine the origin of IL-17.. In the LB group, biopsies showed a significant presence of IL-17+ cells/mm2 of lamina propria compared with the stable, acute A-grade/chronic rejection and infection groups (p < 0.0001). The number of IL-17+ cells on biopsy correlated with percent BAL (%BAL) neutrophilia (r = 0.34, p = 0.0056). Azithromycin reduced both %BAL neutrophilia and IL-17+ cells (both p = 0.016) in the LB group. CD8+ cells were the major source of IL-17.. IL-17+ / CD8+ cells are present in LB after LTx but not in acute A-grade/chronic rejection nor during infection. Moreover, azithromycin significantly decreased the number of IL-17+ cells in the airway wall, which may further explain its effect on BAL neutrophilia.

Topics: Adult; Azithromycin; Bronchiolitis; Female; Humans; Interleukin-17; Lung Transplantation; Lymphocytes; Male; Middle Aged; Neutrophils; Postoperative Complications; Retrospective Studies

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Campylobacter Infections; Campylobacter jejuni; Diagnosis, Differential; Enteritis; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Male; Postoperative Complications

Topics: Azithromycin; Bronchiolitis Obliterans; Humans; Lung Transplantation; Postoperative Complications

Previous studies have suggested that azithromycin improves lung function in lung transplant recipients with bronchiolitis obliterans syndrome (BOS). However, these studies did not include a non-treated BOS control cohort or perform survival analysis. This study was undertaken to estimate the effect of azithromycin treatment on survival in lung transplant recipients with BOS.. We conducted a retrospective cohort study of consecutive lung transplant recipients who developed BOS between 1999 and 2007. An association between azithromycin treatment and death was assessed using univariate and multivariate time-dependent Cox regression analysis.. Of the 178 recipients who developed BOS in our study, 78 did so after 2003 and were treated with azithromycin. The azithromycin-treated and untreated cohorts had similar baseline characteristics. Univariate analysis demonstrated that azithromycin treatment was associated with a survival advantage and this beneficial treatment effect was more pronounced when treatment was initiated during BOS Stage 1. Multivariate analysis demonstrated azithromycin treatment during BOS Stage 1 (adjusted hazard ratio = 0.23, p = 0.01) and absolute forced expiratory volume in 1 second (FEV(1)) at the time of BOS Stage 1 (adjusted hazard ratio = 0.52, p = 0.003) were both associated with a decreased risk of death.. In lung transplant recipients with BOS Stage 1, azithromycin treatment initiated before BOS Stage 2 was independently associated with a significant reduction in the risk of death. This finding supports the need for a randomized, controlled trial to confirm the impact of azithromycin on survival in lung transplant recipients.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Bronchiolitis Obliterans; Cause of Death; Cohort Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Forced Expiratory Volume; Humans; Lung Transplantation; Male; Middle Aged; Opportunistic Infections; Postoperative Complications; Proportional Hazards Models; Pseudomonas Infections; Retrospective Studies; Risk Factors; Survival Analysis

Bartonella henselae is the causative agent of cat-scratch disease and other disorders, including hepatosplenic granulomatosis. This infection has only rarely been reported after solid organ transplantation, where it can mimic the more common post-transplant lymphoproliferative disease. Here we present a case of asymptomatic B. henselae hepatic and lymph nodal granulomatosis in a pediatric patient who had received orthotopic liver transplant 2 months before; we hypothesize that the causative agent was transmitted from the donor. This infection developed early in the post-transplant period; the disease involved only the graft liver and the regional lymph nodes, and the patient did not have a cat or any history of contact, scratches, or bites by a cat. In our patient this infection resolved successfully with a combination of 2 associated antibiotics and reduction of immunosuppressive therapy.

Topics: Amikacin; Anti-Infective Agents; Antibodies, Bacterial; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Child; Humans; Immunosuppressive Agents; Liver; Liver Neoplasms; Liver Transplantation; Lymph Nodes; Lymphomatoid Granulomatosis; Male; Postoperative Complications; RNA, Bacterial; RNA, Ribosomal, 16S; RNA, Ribosomal, 23S; Tacrolimus; Tissue Donors; Transplants; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Biopsy; Bronchoscopy; Humans; Postoperative Complications; Respiratory Tract Infections

Topics: Anti-Bacterial Agents; Azithromycin; Bronchoscopy; Drug Resistance, Microbial; Humans; Postoperative Complications; Respiratory Tract Infections

Assuming that the rate of fetal loss after amniocentesis may be reduced in patients receiving antibiotic prophylaxis, we conducted a retrospective study on untreated versus treated patients receiving prophylactic antibiotics (amoxicillin/clavulanic-acid or azithromycin) and evaluated the fetal loss rate within the 22nd week of gestation, also with respect to the risk of spontaneous abortion, both preexisting and related to mid-trimester amniocentesis.. Spontaneous abortion occurred in 22 cases out of 1744 (1.26%). The incidence of spontaneous abortion was 1.3% among patients treated with antibiotic prophylaxis and 1.2% among untreated patients. Between patients with risk factors that predated amniocentesis, the spontaneous fetal loss rate was 9.2% in untreated patients versus 2.3% in patients treated (p = 0.10). In patients with procedure-related risk factors at amniocentesis, the spontaneous abortion rate was, respectively, 2.2 and 1.2% (p = 0.72).. Our data demonstrate that antibiotic prophylaxis does not reduce the risk of spontaneous abortion within the 22nd week of gestation. Compared with untreated patients, patients treated with amoxicillin showed the lower fetal loss rate (1.16 vs 0.31%), but the difference was not statistically significant (odds ratio (OR) = 3.68, p = 0.32). The same was true for patients with preexisting risks (OR = 4.25, p = 0.10).

Topics: Abortion, Spontaneous; Adult; Amniocentesis; Amoxicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Clavulanic Acid; Drug Therapy, Combination; Female; Humans; Incidence; Italy; Postoperative Complications; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies

Rotational use of antimicrobials is one of the strategies that have been suggested to reduce the development of drug-resistant bacteria. Cycling of homogeneous antimicrobial exposure is, however, unlikely to control the emergence of antimicrobial resistance. Penicillins and cephalosporins have been extensively used for therapeutic and prophylactic management of oral infection. The aim of the study was to investigate the clinical effects of azithromycin as prophylaxis on the prevention of postoperative infection in impacted mandibular third-molar surgery. The study design was a retrospective, single-center review. One (2.2%) of all 45 patients exhibited dry socket infection. In several categories, there was significant effectiveness of azithromycin in comparison with other antimicrobials, although there was no significant difference in the occurrence rate of dry socket infection. Azithromycin might be of value for prophylactic use in impacted mandibular third-molar surgery in which penicillins and cephalosporins were mainly used. Therefore, it might be available for one of the rotational agents.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Female; Humans; Male; Mandible; Middle Aged; Molar, Third; Postoperative Complications; Retrospective Studies; Surgical Wound Infection; Tooth, Impacted; Treatment Outcome

Topics: Abortion, Induced; Adult; Antibiotic Prophylaxis; Azithromycin; Cohort Studies; Female; France; Humans; Multicenter Studies as Topic; Postoperative Complications; Pregnancy; Randomized Controlled Trials as Topic; Risk Factors; Tetracyclines

To describe the time course, diagnosis, clinical features, and treatment of seven patients with Mycobacterium szulgai keratitis that developed from 7 to 24 weeks after laser in situ keratomileusis (LASIK).. Seven of 30 eyes of 18 patients were identified with keratitis after LASIK. The first two patients presented 12 to 14 weeks after LASIK; nontuberculous mycobacteria were identified 1 month after the flaps were cultured. Patient recall identified three additional cases by culture and two cases by clinical features alone. Pulsed-field gel electrophoresis (PFGE) was used to type the isolates, and treatment was modified based on susceptibilities.. M. szulgai was identified in five patients for whom cultures were performed, but response to empiric therapy based on cultures proved unsatisfactory. The keratitis resolved in all patients with treatment including clarithromycin based on susceptibilities. Medical therapy was sufficient, although one patient required flap amputation. Six of seven patients recovered best-corrected visual acuity (BCVA), while one patient lost one line of BCVA. Two patients lost one line of postoperative uncorrected visual acuity (UCVA), two patients gained one line of UCVA, and three patients recovered postoperative UCVA. PFGE analysis revealed that the M. szulgai strains were identical, and the infection source was contaminated ice used to chill syringes for saline lavage.. Nontuberculous mycobacterial keratitis after LASIK is a diagnostic and management challenge, but outcomes can be preserved with treatment based on susceptibilities. This cluster underscores the importance of adherence to sterile protocol during LASIK.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Equipment Contamination; Female; Humans; Keratitis; Keratomileusis, Laser In Situ; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Postoperative Complications; Risk Factors; Time Factors

Rhodococcus equi is a common cause of pneumonia in animals. Human infection is rare. Increasing number of cases are being reported in immunosuppressed individuals mostly associated with HIV infection, but also in solid organ transplant recipients and leukemia/lymphoma patients. We report on an adult male who developed pneumonia and gastroenteritis 4 mo after receiving a renal transplant. CT scan of the lungs showed a dominant 2.5-cm upper lobe lung mass and smaller bilateral nodules. He underwent a diagnostic bronchoscopy with fine-needle aspiration biopsy of the largest lung nodule. Smears showed histiocytic granulomatous inflammation, foamy macrophages, and acute inflammatory exudate. Scattered foamy macrophages displayed intracellular coccobacilli identifiable on Diff-Quik stain. A few cells with changes suggestive of viral inclusions were identified. Cytomegalovirus (CMV) immunostain was positive in the cell block sections. Lung cultures grew R. equi. To the best of our knowledge, this is the first report of coinfection with R. equi and CMV.

Topics: Actinomycetales Infections; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Antigens, Viral; Antiviral Agents; Azithromycin; Biopsy, Needle; Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; Humans; Immunocompromised Host; Kidney Transplantation; Male; Ofloxacin; Pneumonia, Bacterial; Pneumonia, Viral; Postoperative Complications; Rhodococcus; Tomography, X-Ray Computed; Vancomycin

A patient with mechanical heart valves developed bleeding, after the introduction of amiodarone and azithromycin. Though the anticoagulant effect could be neutralized, the patient succumbed to heart failure. Any new drug prescribed to patients on anticoagulant must be assessed for its potential for interaction and warrants frequent prothrombin time testing.

Topics: Amiodarone; Anticoagulants; Atrial Fibrillation; Azithromycin; Coumarins; Drug Interactions; Fatal Outcome; Female; Heart Valve Prosthesis Implantation; Hemorrhage; Humans; Middle Aged; Postoperative Complications; Respiratory Tract Infections

Gingival hyperplasia is a well recognised complication of cyclosporin A therapy. Although its pathogenesis is still debated in several recent reports a second generation macrolide antibiotic-azithromycin induced partial or even complete regression of hyperplasia. We present a patient after kidney transplantation treated with cyclosporin who developed very advanced gigival overgrowth (stage 3+). The patient received a 3-day treatment with azithromycin which was repeated after 3 months. The first course of the drug caused a partial regression of gingival hyperplasia during following months but the repeated treatment did not provide a further regression of the changes.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Cyclosporine; Female; Gingival Hyperplasia; Humans; Immunosuppressive Agents; Kidney Transplantation; Postoperative Complications