1. Maternal azithromycin therapy for Ureaplasma intraamniotic infection delays preterm delivery and reduces fetal lung injury in a primate model.
- Author
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Grigsby PL, Novy MJ, Sadowsky DW, Morgan TK, Long M, Acosta E, Duffy LB, and Waites KB
- Subjects
- Animals, Anti-Inflammatory Agents administration & dosage, Anti-Inflammatory Agents, Non-Steroidal administration & dosage, Chorioamnionitis microbiology, Dexamethasone administration & dosage, Drug Therapy, Combination, Female, Fetal Diseases prevention & control, Indomethacin administration & dosage, Macaca mulatta, Polymerase Chain Reaction, Pregnancy, Treatment Outcome, Ureaplasma drug effects, Ureaplasma Infections microbiology, Anti-Bacterial Agents administration & dosage, Azithromycin administration & dosage, Chorioamnionitis drug therapy, Lung Injury prevention & control, Premature Birth prevention & control, Ureaplasma isolation & purification, Ureaplasma Infections drug therapy
- Abstract
Objective: We assessed the efficacy of a maternal multidose azithromycin (AZI) regimen, with and without antiinflammatory agents to delay preterm birth and to mitigate fetal lung injury associated with Ureaplasma parvum intraamniotic infection., Study Design: Long-term catheterized rhesus monkeys (n = 16) received intraamniotic inoculation of U parvum (10(7) colony-forming U/mL, serovar 1). After contraction onset, rhesus monkeys received no treatment (n = 6); AZI (12.5 mg/kg, every 12 h, intravenous for 10 days; n = 5); or AZI plus dexamethasone and indomethacin (n = 5). Outcomes included amniotic fluid proinflammatory mediators, U parvum cultures and polymerase chain reaction, AZI pharmacokinetics, and the extent of fetal lung inflammation., Results: Maternal AZI therapy eradicated U parvum intraamniotic infection from the amniotic fluid within 4 days. Placenta and fetal tissues were 90% culture negative at delivery. AZI therapy significantly delayed preterm delivery and prevented advanced fetal lung injury, although residual acute chorioamnionitis persisted., Conclusion: Specific maternal antibiotic therapy can eradicate U parvum from the amniotic fluid and key fetal organs, with subsequent prolongation of pregnancy, which provides a therapeutic window of opportunity to effectively reduce the severity of fetal lung injury., (Copyright © 2012 Mosby, Inc. All rights reserved.)
- Published
- 2012
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