The placental transfer of erythromycin in human pregnancies with group B streptococcal infection

Bulska, M; Szcześniak, Piotr; Pięta-Dolińska, Agnieszka; Oszukowski, Przemysław; Orszulak–Michalak, Daria

doi:10.17772/gp/1896

Cited by 23 publications

(16 citation statements)

References 6 publications

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“…Erythromycin is used primarily as an anti-inflammatory for the treatment of chronic inflammatory lung disease (panbronchiolitis) [ 71 , 72 ] and has been shown to have tocolytic action in vitro [ 73 ]. Considering that the placental transfer of erythromycin into the fetal circulation is low (approximately 2%) [ 74 ], neonatal benefits are more likely due to action on maternal tissues and subsequent inhibition of inflammatory mediators that could cross the placenta. Nevertheless, vaginal delivery acts as a high-dose inoculum to the neonate, which shapes the composition of the early infant gut microbiome [ 25 , 75 – 78 ], which is in turn linked to short-term and long-term health outcomes [ 79 , 80 ].…”

Section: Discussionmentioning

confidence: 99%

Vaginal dysbiosis increases risk of preterm fetal membrane rupture, neonatal sepsis and is exacerbated by erythromycin

Brown

Marchesi

Lee

et al. 2018

BMC Med

224

215

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BackgroundPreterm prelabour rupture of the fetal membranes (PPROM) precedes 30% of preterm births and is a risk factor for early onset neonatal sepsis. As PPROM is strongly associated with ascending vaginal infection, prophylactic antibiotics are widely used. The evolution of vaginal microbiota compositions associated with PPROM and the impact of antibiotics on bacterial compositions are unknown.MethodsWe prospectively assessed vaginal microbiota prior to and following PPROM using MiSeq-based sequencing of 16S rRNA gene amplicons and examined the impact of erythromycin prophylaxis on bacterial load and community structures.ResultsIn contrast to pregnancies delivering at term, vaginal dysbiosis characterised by Lactobacillus spp. depletion was present prior to the rupture of fetal membranes in approximately a third of cases (0% vs. 27%, P = 0.026) and persisted following membrane rupture (31%, P = 0.005). Vaginal dysbiosis was exacerbated by erythromycin treatment (47%, P = 0.00009) particularly in women initially colonised by Lactobacillus spp. Lactobacillus depletion and increased relative abundance of Sneathia spp. were associated with subsequent funisitis and early onset neonatal sepsis.ConclusionsOur data show that vaginal microbiota composition is a risk factor for subsequent PPROM and is associated with adverse short-term maternal and neonatal outcomes. This highlights vaginal microbiota as a potentially modifiable antenatal risk factor for PPROM and suggests that routine use of erythromycin for PPROM be re-examined.Electronic supplementary materialThe online version of this article 10.1186/s12916-017-0999-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Vaginal dysbiosis increases risk of preterm fetal membrane rupture, neonatal sepsis and is exacerbated by erythromycin

Brown

Marchesi

Lee

et al. 2018

BMC Med

224

215

View full text Add to dashboard Cite

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“…Prenatal erythromycin exposure was not associated with IHPS based on the pooled results of either the cohort studies or the case-control studies. Although the placental transfer of erythromycin is documented, the amount transferred is limited to around 2.6% of the maternal serum concentration [32]. Limited transplacental transfer has also been observed for roxithromycin and azithromycin [33].…”

Section: Discussionmentioning

confidence: 99%

The association of prenatal and postnatal macrolide exposure with subsequent development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis

Almaramhy

Al‐Zalabani

2019

Ital J Pediatr

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BackgroundThe association between macrolides use and subsequent occurrence of infantile hypertrophic pyloric stenosis (IHPS) is still debatable. The aim of this study was to conduct a systematic review and meta-analysis of the association between perinatal exposure to macrolides, mainly erythromycin, and the development of pyloric stenosis.MethodsOriginal studies were identified using MEDLINE, Web of Science, Scopus, Google Scholar, and the Cochrane Library databases. Studies investigating the association between perinatal exposure to macrolides and pyloric stenosis were included. The most adjusted effect estimates were pooled using random-effects meta-analysis. The I2 and Egger’s tests were used to assess heterogeneity and publication bias, respectively.ResultsFourteen papers (12 retrospective cohort studies and two case-control studies) were included. For postnatal exposure, the overall estimate of seven cohort studies indicated a statistically significant association (RR = 3.17, 95% CI: 2.38–4.23; I2 = 10.0%) with no evidence of publication bias (Egger P = 0.81). For prenatal exposure, six cohort studies and two case-control studies were included. Meta-analysis demonstrated a statistically significant association in the cohort studies (OR = 1.47, 95% CI: 1.03–2.09; I2 = 29.3%), but not in the case-control studies (OR = 1.02, 95% CI: 0.66–1.58; I2 = 51.2%). The overall pooled result was not statistically significant. Only two studies were included for exposure through breastfeeding, and the estimates did not show a statistically significant association (OR = 1.31; 95% CI: 0.42–4.1; I2 = 69.1%).ConclusionsThe study demonstrated good evidence of association between development of IHPS and direct postnatal exposure to macrolides. However, the evidence on the effects of prenatal exposure or postnatal maternal exposure (breastfeeding) is not conclusive.

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“…Less hygienic standards in rural hospitals might be an explanation for this. Some studies showed placental transfer of antibiotics such as erythromycin in humans [45]. This might be a reason for delayed colonization with intestinal resistant bacteria in neonates.…”

Section: Discussionmentioning

confidence: 99%

“Enhanced acquisition of antibiotic-resistant intestinal E. coli during the first year of life assessed in a prospective cohort study”

Hetzer

Orth‐Höller

Würzner

et al. 2019

Antimicrob Resist Infect Control

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Background Increasing bacterial resistance to antibiotics is a serious problem worldwide. We sought to record the acquisition of antibiotic-resistant Escherichia coli ( E. coli ) in healthy infants in Northern Thailand and investigated potential determinants. Methods Stool samples from 142 infants after birth, at ages 2wk, 2mo, 4 to 6mo, and 1y, and parent stool samples were screened for E. coli resistance to tetracycline, ampicillin, co-trimoxazole, and cefazoline by culture, and isolates were further investigated for multiresistance by disc diffusion method. Pulsed-field gel electrophoresis was performed to identify persistent and transmitted strains. Genetic comparison of resistant and transmitted strains was done by multilocus sequence typing (MLST) and strains were further investigated for extra- and intra-intestinal virulence factors by multiplex PCR. Results Forty-seven (33%) neonatal meconium samples contained resistant E. coli. Prevalence increased continuously: After 1y, resistance proportion (tetracycline 80%, ampicillin 72%, co-trimoxazole 66%, cefazoline 35%) almost matched those in parents. In 8 infants (6%), identical E. coli strains were found in at least 3 sampling time points (suggesting persistence). Transmission of resistant E. coli from parents to child was observed in only 8 families. MLST showed high diversity. We could not identify any virulence genes or factors associated with persistence, or transmission of resistant E. coli . Full-term, vaginal birth and birth in rural hospital were identified as risk factors for early childhood colonization with resistant E. coli . Conclusion One third of healthy Thai neonates harboured antibiotic-resistant E. coli in meconium. The proportion of resistant E. coli increased during the first year of life almost reaching the value in adults. We hypothesize that enhancement of infection control measures and cautious use of antibiotics may help to control further increase of resistance. Electronic supplementary material The online version of this article (10.1186/s13756-019-0522-6) contains supplementary material, which is available to authorized users.

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The placental transfer of erythromycin in human pregnancies with group B streptococcal infection

Cited by 23 publications

References 6 publications

Vaginal dysbiosis increases risk of preterm fetal membrane rupture, neonatal sepsis and is exacerbated by erythromycin

Vaginal dysbiosis increases risk of preterm fetal membrane rupture, neonatal sepsis and is exacerbated by erythromycin

The association of prenatal and postnatal macrolide exposure with subsequent development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis

“Enhanced acquisition of antibiotic-resistant intestinal E. coli during the first year of life assessed in a prospective cohort study”

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