zithromax and Respiratory-Distress-Syndrome--Newborn

Topics: ATP-Binding Cassette Transporters; Azithromycin; Humans; Infant, Newborn; Lung Diseases, Interstitial; Mutation; Respiratory Distress Syndrome, Newborn

Preterm premature rupture of membranes complicates 2-3% of pregnancies. Many institutions have advocated for the use of azithromycin instead of erythromycin. This is secondary to national shortages of erythromycin, ease of administration, better side effect profile, and decreased cost of azithromycin as compared with erythromycin.. The objective of the study was to evaluate whether there are differences in the latency from preterm premature rupture of membranes to delivery in patients treated with different dosing regimens of azithromycin vs erythromycin.. Four hundred fifty-three patients who met inclusion criteria were identified. Seventy-eight patients received azithromycin for 1 day, 191 patients received azithromycin for 5 days, 52 patients received azithromycin for 7 days, and 132 patients received erythromycin. Women who received the 5 day regimen were younger and less likely to be non-African American, have hypertension, have sexually transmitted infection, or experienced substance abuse. There was no statistical difference in median latency time of azithromycin 1 day (4.9 days, 95% confidence interval, 3.3-6.4), azithromycin 5 days (5.0, 95% confidence interval, 3.9-6.1), or azithromycin 7 days (4.9 days, 95% confidence interval, 2.8-7.0) when compared with erythromycin (5.1 days, 95% confidence interval, 3.9-6.4) after adjusting for demographic variables (P = .99). Clinical chorioamnionitis was not different between groups in the adjusted model. Respiratory distress syndrome was increased in the azithromycin 5 day group vs azithromycin 1 day vs erythromycin (44% vs. 29% and 29%, P = .005, respectively).. There was no difference in latency to delivery, incidence of chorioamnionitis, or neonatal outcomes when comparing different dosing regimens of the azithromycin with erythromycin, with the exception of respiratory distress syndrome being more common in the 5 day azithromycin group. Azithromycin could be considered as an alternative to erythromycin in the expectant management of preterm premature rupture of membranes if erythromycin is unavailable or contraindicated. There appears to be no additional benefit to an extended course of azithromycin beyond the single-day dosing, but final recommendations on dosing strategies should rely on clinical trials.

Topics: Adult; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Azithromycin; Chorioamnionitis; Cohort Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Erythromycin; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Length of Stay; Pregnancy; Respiratory Distress Syndrome, Newborn; Retrospective Studies

Mutations in adenosine triphosphate-binding cassette transporter A3 (ABCA3) (OMIM: 601615) gene constitute the most frequent genetic cause of severe neonatal respiratory distress syndrome (RDS) and interstitial lung disease (ILD) in children. Interstitial lung disease in children and especially in infants, in contrast to adults, is more likely to appear as a result of developmental deficits or is characterized by genetic aberrations of pulmonary surfactant homeostasis not responding to exogenous surfactant administration. The underlying ABCA3 gene mutations are commonly thought, regarding null mutations, to determine the clinical course of the disease while there exist mutation types, especially missense variants, whose effects on surfactant proteins are difficult to predict. In addition, clinical and radiological signs overlap with those of surfactant proteins B and C mutations making diagnosis challenging. We demonstrate a case of a one-term newborn male with lethal respiratory failure caused by homozygous missense ABCA3 gene mutation c.3445G>A (p.Asp1149Asn), which, to our knowledge, was not previously reported as a causative agent of newborn lethal RDS. Therapeutic strategies for patients with ABCA3 gene mutations are not sufficiently evidence-based. Therefore, the description of the clinical course and treatment of the disease in terms of a likely correlation between genotype and phenotype is crucial for the development of the optimal clinical approach for affected individuals.

Topics: Adrenal Cortex Hormones; ATP-Binding Cassette Transporters; Azithromycin; Humans; Hydroxychloroquine; Infant, Newborn; Lung Diseases, Interstitial; Male; Mutation; Pulmonary Surfactants; Respiratory Distress Syndrome, Newborn; Tomography, X-Ray Computed

Topics: Azithromycin; Betamethasone; Humans; Infant, Newborn; Infant, Premature; Intensive Care, Neonatal; Male; Mycoplasma pneumoniae; Pneumonia, Mycoplasma; Radiography, Thoracic; Respiration, Artificial; Respiratory Distress Syndrome, Newborn

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; ATP-Binding Cassette Transporters; Azithromycin; Drug Therapy, Combination; Enzyme Inhibitors; Humans; Hydroxychloroquine; Infant, Newborn; Lung Diseases, Interstitial; Lung Transplantation; Male; Methylprednisolone; Pulmonary Alveolar Proteinosis; Respiration, Artificial; Respiratory Distress Syndrome, Newborn