Erythromycin for the prevention of chronic lung disease in intubated preterm infants at risk for, or colonized or infected with Ureaplasma urealyticum

Abstract

Current evidence does not demonstrate a reduction in CLD/death when intubated preterm infants are treated with erythromycin prophylactically before U. urealyticum culture/PCR results are known or when Ureaplasma colonized, intubated preterm infants are treated with erythromycin. However, a true benefit could easily have been missed with the small sample sizes in the two eligible studies. The studies were greatly underpowered to detect uncommon adverse effects such as pyloric stenosis. Additional controlled trials are required to determine whether antibiotic therapy of Ureaplasma reduces CLD and/or death in intubated preterm infants.

The significance of Ureaplasma urealyticum as a pathogenic agent in the paediatric population

“…Furthermore, in that study, macrolide administration did not advantageously influence the duration of mechanical ventilation, continuous positive airway pressure, or the total duration of supplemental oxygen administration for these infants. This outcome is consistent with previous treatment trials, both randomized and non-randomized [17,[67][68][69][70][71][72][73][74]. In the study by Jonsson et al [67], cultures became negative in a significant number of respiratory colonized infants after 10 days of erythromycin treatment, whereas cultures remained positive in all the recultured U. urealyticum-positive infants who did not receive treatment.…”

The significance of Ureaplasma urealyticum as a pathogenic agent in the paediatric population

“…Furthermore, in that study, macrolide administration did not advantageously influence the duration of mechanical ventilation, continuous positive airway pressure, or the total duration of supplemental oxygen administration for these infants. This outcome is consistent with previous treatment trials, both randomized and non-randomized [17,[67][68][69][70][71][72][73][74]. In the study by Jonsson et al [67], cultures became negative in a significant number of respiratory colonized infants after 10 days of erythromycin treatment, whereas cultures remained positive in all the recultured U. urealyticum-positive infants who did not receive treatment.…”

Role of pulmonary infection in the development of chronic lung disease of prematurity

“…Data are presented as n (%) or n. RDS: respiratory distress syndrome; CLD: chronic lung disease. decrease the rates of CLD [23,24]. Our data also suggest that late manifestation of Ureaplasma spp., whether acquired antenatally or not, will need to be considered in the causation of CLD and be accounted for in any future interventional trials investigating if eradication of pulmonary Ureaplasma spp.…”

Efficacy of macrolides on gastric motility in extremely low birth weight infants

“…We did not find any significant difference in the prevalence of CLD and requirement for home oxygen therapy in patients in the present study. A systematic review on the effect of EM on preventing CLD did not show favorable efficacy, whereas azithromycin and CAM were suggested to be effective in other studies [7, 15]. The present study was retrospectively designed and the duration of mechanical ventilation and hospitalization in the treated group was longer than that in the untreated group.…”

The significance of Ureaplasma urealyticum as a pathogenic agent in the paediatric population

“…Furthermore, in that study, macrolide administration did not advantageously influence the duration of mechanical ventilation, continuous positive airway pressure, or the total duration of supplemental oxygen administration for these infants. This outcome is consistent with previous treatment trials, both randomized and non-randomized [17,[67][68][69][70][71][72][73][74]. In the study by Jonsson et al [67], cultures became negative in a significant number of respiratory colonized infants after 10 days of erythromycin treatment, whereas cultures remained positive in all the recultured U. urealyticum-positive infants who did not receive treatment.…”

Role of pulmonary infection in the development of chronic lung disease of prematurity

“…Data are presented as n (%) or n. RDS: respiratory distress syndrome; CLD: chronic lung disease. decrease the rates of CLD [23,24]. Our data also suggest that late manifestation of Ureaplasma spp., whether acquired antenatally or not, will need to be considered in the causation of CLD and be accounted for in any future interventional trials investigating if eradication of pulmonary Ureaplasma spp.…”

Efficacy of macrolides on gastric motility in extremely low birth weight infants

“…We did not find any significant difference in the prevalence of CLD and requirement for home oxygen therapy in patients in the present study. A systematic review on the effect of EM on preventing CLD did not show favorable efficacy, whereas azithromycin and CAM were suggested to be effective in other studies [7, 15]. The present study was retrospectively designed and the duration of mechanical ventilation and hospitalization in the treated group was longer than that in the untreated group.…”

The significance of Ureaplasma urealyticum as a pathogenic agent in the paediatric population

“…Furthermore, in that study, macrolide administration did not advantageously influence the duration of mechanical ventilation, continuous positive airway pressure, or the total duration of supplemental oxygen administration for these infants. This outcome is consistent with previous treatment trials, both randomized and non-randomized [17,[67][68][69][70][71][72][73][74]. In the study by Jonsson et al [67], cultures became negative in a significant number of respiratory colonized infants after 10 days of erythromycin treatment, whereas cultures remained positive in all the recultured U. urealyticum-positive infants who did not receive treatment.…”

Role of pulmonary infection in the development of chronic lung disease of prematurity

“…Data are presented as n (%) or n. RDS: respiratory distress syndrome; CLD: chronic lung disease. decrease the rates of CLD [23,24]. Our data also suggest that late manifestation of Ureaplasma spp., whether acquired antenatally or not, will need to be considered in the causation of CLD and be accounted for in any future interventional trials investigating if eradication of pulmonary Ureaplasma spp.…”

Efficacy of macrolides on gastric motility in extremely low birth weight infants

“…We did not find any significant difference in the prevalence of CLD and requirement for home oxygen therapy in patients in the present study. A systematic review on the effect of EM on preventing CLD did not show favorable efficacy, whereas azithromycin and CAM were suggested to be effective in other studies [7, 15]. The present study was retrospectively designed and the duration of mechanical ventilation and hospitalization in the treated group was longer than that in the untreated group.…”