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Lowe J, Gillespie D, Aboklaish A, Lau TMM, Consoli C, Babu M, Goddard M, Hood K, Klein N, Thomas-Jones E, Turner M, Hubbard M, Marchesi J, Berrington J, Kotecha S. Azithromycin therapy for prevention of chronic lung disease of prematurity (AZTEC): a multicentre, double-blind, randomised, placebo-controlled trial. THE LANCET. RESPIRATORY MEDICINE 2024:S2213-2600(24)00079-1. [PMID: 38679042 DOI: 10.1016/s2213-2600(24)00079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Systematic reviews have reported conflicting evidence on whether macrolide antibiotics reduce rates of chronic lung disease of prematurity (CLD) in at-risk preterm infants born at less than 30 weeks' gestation, including in those colonised with pulmonary Ureaplasma spp. Since an adequately powered trial has been lacking, we aimed to assess if the macrolide azithromycin improved survival without the development of physiologically defined moderate or severe CLD in preterm infants. METHODS AZTEC was a multicentre, double-blind, randomised, placebo-controlled trial conducted in 28 tertiary neonatal intensive care units in the UK. Infants were eligible if they were born at less than 30 weeks' gestation and had received at least 2 h of either non-invasive (continuous positive airway pressure or humidified high flow nasal cannula therapy) or invasive respiratory support (via endotracheal tube) within 72 h of birth. Eligible infants were randomly allocated in a 1:1 ratio using random permuted blocks of four to receive either intravenous azithromycin at 20 mg/kg per day for 3 days followed by 10 mg/kg for 7 days, or to placebo. Allocation was stratified by centre and gestational age at birth (<28 weeks vs ≥28 weeks). Azithromycin and placebo vials were encased in tamper-evident custom cardboard cartons to ensure masking for clinicians, parents, and the research team. The primary outcome was survival without development of physiologically defined moderate or severe CLD at 36 weeks' postmenstrual age. Outcomes and safety were analysed on an intention-to-treat basis (all randomly allocated infants, regardless of any post-randomisation events). The study was registered with ISRCRN (11650227) and is closed. FINDINGS Infants were recruited between Oct 9, 2019, and March 22, 2022. 799 (53·1%) of 1505 eligible infants underwent random allocation; three infants were withdrawn, including consent to use their data, leaving 796 infants for analysis. Survival without moderate or severe CLD occurred in 166 (42%) of 394 infants in the intervention group and 179 (45%) of 402 in the placebo group (three-level adjusted OR [aOR] 0·84, 95% CI 0·55-1·29, p=0·43). Pulmonary Ureaplasma spp colonisation did not influence treatment effect. Overall, seven serious adverse events were reported for the azithromycin group (five graded as severe, two as moderate), and six serious adverse events were reported in the placebo group (two severe, two moderate, and two mild), as assessed by the local principal investigators. INTERPRETATION Since prophylactic use of azithromycin did not improve survival without development of physiologically-defined CLD, regardless of Ureaplasma spp colonisation, it cannot be recommended in clinical practice. FUNDING UK National Institute for Health and Care Research.
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Affiliation(s)
- John Lowe
- Centre For Trials Research, Cardiff University, Cardiff, UK
| | | | - Ali Aboklaish
- Department of Child Health, Cardiff University School of Medicine, Cardiff, UK
| | | | - Claudia Consoli
- Central Biotechnology Services, Cardiff University, Cardiff, UK
| | - Malavika Babu
- Centre For Trials Research, Cardiff University, Cardiff, UK
| | - Mark Goddard
- Centre For Trials Research, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Centre For Trials Research, Cardiff University, Cardiff, UK
| | - Nigel Klein
- Institute of Child Health, University College London, London, UK
| | | | - Mark Turner
- Women and Children's Health, University of Liverpool, Liverpool, UK
| | - Marie Hubbard
- Neonatal Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Julian Marchesi
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Janet Berrington
- Neonatal Medicine, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, UK.
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Razak A. Azithromycin for the prevention of chronic lung disease of prematurity: not a silver bullet. THE LANCET. RESPIRATORY MEDICINE 2024:S2213-2600(24)00086-9. [PMID: 38679043 DOI: 10.1016/s2213-2600(24)00086-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Abdul Razak
- Department of Paediatrics, Monash University, Melbourne VIC, Australia; Monash Newborn, Monash Children's Hospital, Melbourne VIC, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne VIC, Australia.
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Pandya CD, Vekaria HJ, Zamorano M, Trout AL, Ritzel RM, Guzman GU, Bolden C, Sullivan PG, Gensel JC, Miller BA. Azithromycin reduces hemoglobin-induced innate neuroimmune activation. Exp Neurol 2024; 372:114574. [PMID: 37852468 DOI: 10.1016/j.expneurol.2023.114574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/11/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023]
Abstract
Neonatal intraventricular hemorrhage (IVH) releases blood products into the lateral ventricles and brain parenchyma. There are currently no medical treatments for IVH and surgery is used to treat a delayed effect of IVH, post-hemorrhagic hydrocephalus. However, surgery is not a cure for intrinsic brain injury from IVH, and is performed in a subacute time frame. Like many neurological diseases and injuries, innate immune activation is implicated in the pathogenesis of IVH. Innate immune activation is a pharmaceutically targetable mechanism to reduce brain injury and post-hemorrhagic hydrocephalus after IVH. Here, we tested the macrolide antibiotic azithromycin, which has immunomodulatory properties, to reduce innate immune activation in an in vitro model of microglial activation using the blood product hemoglobin (Hgb). We then utilized azithromycin in our in vivo model of IVH, using intraventricular blood injection into the lateral ventricle of post-natal day 5 rat pups. In both models, azithromycin modulated innate immune activation by several outcome measures including mitochondrial bioenergetic analysis, cytokine expression and flow cytometric analysis. This suggests that azithromycin, which is safe for neonates, could hold promise for modulating innate immune activation after IVH.
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Affiliation(s)
- Chirayu D Pandya
- Center for Advanced Translational Stroke Science (CATSS), Department of Neurosurgery, University of Kentucky College of Medicine, Lexington, KY 40536, United States of America
| | - Hemendra J Vekaria
- Spinal Cord and Brain Injury Research Center (SCoBIRC), Department of Neuroscience, University of Kentucky College of Medicine, Lexington, KY 40536, United States of America
| | - Miriam Zamorano
- Department of Pediatric Surgery, University of Texas Health Science Center at Houston, 77030, United States of America
| | - Amanda L Trout
- Center for Advanced Translational Stroke Science (CATSS), Department of Neurosurgery, University of Kentucky College of Medicine, Lexington, KY 40536, United States of America
| | - Rodney M Ritzel
- Lexington Veterans' Affairs Healthcare System, Lexington, KY 40502, United States of America
| | - Gary U Guzman
- Lexington Veterans' Affairs Healthcare System, Lexington, KY 40502, United States of America
| | - Christopher Bolden
- Department of Pediatric Surgery, University of Texas Health Science Center at Houston, 77030, United States of America
| | - Patrick G Sullivan
- Spinal Cord and Brain Injury Research Center (SCoBIRC), Department of Neuroscience, University of Kentucky College of Medicine, Lexington, KY 40536, United States of America; Lexington Veterans' Affairs Healthcare System, Lexington, KY 40502, United States of America
| | - John C Gensel
- Spinal Cord and Brain Injury Research Center (SCoBIRC), Department of Physiology, University of Kentucky College of Medicine, Lexington, KY 40536, United States of America
| | - Brandon A Miller
- Department of Pediatric Surgery, University of Texas Health Science Center at Houston, 77030, United States of America.
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Ryan RM, Mukherjee D, Ford S, Lingappan K. Pharmacotherapy of BPD: Current status & future perspectives. Semin Perinatol 2023; 47:151819. [PMID: 37783580 DOI: 10.1016/j.semperi.2023.151819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Bronchopulmonary dysplasia (BPD) is a disease exclusive to prematurity and has changed in its definition since Northway first described it in 1967. There have been countless clinical trials evaluating the efficacy of drugs in the treatment and prevention of BPD in human subjects, and an even larger number of animal studies. Despite these, only a handful of drugs are used at the bedside today, primarily due to the lack of consistent efficacy seen in clinical trials or due to reports of adverse effects. This review summarizes the list of the most commonly used drugs and emerging new therapies which target BPD and BPD-related pulmonary hypertension (BPD-PH), including those which have shown promise in human trials but are not yet used routinely.
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Affiliation(s)
- Rita M Ryan
- UH Rainbow Babies & Children's Hospital and Case Western Reserve University, Cleveland, OH
| | - Devashis Mukherjee
- UH Rainbow Babies & Children's Hospital and Case Western Reserve University, Cleveland, OH.
| | - Stephanie Ford
- UH Rainbow Babies & Children's Hospital and Case Western Reserve University, Cleveland, OH
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Borgonovo F, Quici M, Gidaro A, Giustivi D, Cattaneo D, Gervasoni C, Calloni M, Martini E, La Cava L, Antinori S, Cogliati C, Gori A, Foschi A. Physicochemical Characteristics of Antimicrobials and Practical Recommendations for Intravenous Administration: A Systematic Review. Antibiotics (Basel) 2023; 12:1338. [PMID: 37627758 PMCID: PMC10451375 DOI: 10.3390/antibiotics12081338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Most antimicrobial drugs need an intravenous (IV) administration to achieve maximum efficacy against target pathogens. IV administration is related to complications, such as tissue infiltration and thrombo-phlebitis. This systematic review aims to provide practical recommendations about diluent, pH, osmolarity, dosage, infusion rate, vesicant properties, and phlebitis rate of the most commonly used antimicrobial drugs evaluated in randomized controlled studies (RCT) till 31 March 2023. The authors searched for available IV antimicrobial drugs in RCT in PUBMED EMBASE®, EBSCO® CINAHL®, and the Cochrane Controlled Clinical trials. Drugs' chemical features were searched online, in drug data sheets, and in scientific papers, establishing that the drugs with a pH of <5 or >9, osmolarity >600 mOsm/L, high incidence of phlebitis reported in the literature, and vesicant drugs need the adoption of utmost caution during administration. We evaluated 931 papers; 232 studies were included. A total of 82 antimicrobials were identified. Regarding antibiotics, 37 reach the "caution" criterion, as well as seven antivirals, 10 antifungals, and three antiprotozoals. In this subgroup of antimicrobials, the correct vascular access device (VAD) selection is essential to avoid complications due to the administration through a peripheral vein. Knowing the physicochemical characteristics of antimicrobials is crucial to improve the patient's safety significantly, thus avoiding administration errors and local side effects.
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Affiliation(s)
- Fabio Borgonovo
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Massimiliano Quici
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Antonio Gidaro
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Davide Giustivi
- Emergency Department and Vascular Access Team ASST Lodi, 26900 Lodi, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Cristina Gervasoni
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Maria Calloni
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Elena Martini
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Leyla La Cava
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Spinello Antinori
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Chiara Cogliati
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Andrea Gori
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Antonella Foschi
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
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Chang E, Ballard KE, Johnson PN, Nandyal R, Miller JL. Azithromycin for Eradication of Ureaplasma and Prevention of Bronchopulmonary Dysplasia in Preterm Neonates in the Neonatal Intensive Care Unit. J Pediatr Pharmacol Ther 2023; 28:10-19. [PMID: 36777984 PMCID: PMC9901312 DOI: 10.5863/1551-6776-28.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/01/2022] [Indexed: 02/05/2023]
Abstract
Azithromycin has been explored as a treatment option for eradication of Ureaplasma and prevention of bronchopulmonary dysplasia (BPD) in preterm neonates. However, there is debate about the need for eradication of Ureaplasma and whether azithromycin is safe and efficacious for this indication. This literature review provides an overview of the evidence for use of azithromycin for eradication of Ureaplasma and prevention of BPD, including dosing and duration of azithromycin used in these studies. The literature search included articles published in the English language in Medline and PubMed from 1946 to January 2022. Relevant citations within identified articles were also reviewed. A total of 9 studies representing 388 neonates were included. The percentage of neonates that tested positive for Ureaplasma in these studies ranged from 18.6% to 57.1%. Azithromycin was initiated at <3 days of life in 8 studies (88.9%). Dosing was variable and ranged from 5 to 20 mg/kg/dose administered once daily, and the duration of treatment ranged from 1 to 35 days. Most studies used intravenous azithromycin. Overall, azithromycin was more efficacious than placebo at Ureaplasma eradication; however, most of these studies did not find a difference in the incidence of BPD between patients receiving azithromycin versus placebo. No adverse effects, specifically pyloric stenosis or QT interval prolongation, were noted in these studies.
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Affiliation(s)
- Eugenie Chang
- Department of Pharmacy: Clinical and Administrative Sciences (EC, KEB, PNJ, JLM), University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma
| | - Kaci E Ballard
- Department of Pharmacy: Clinical and Administrative Sciences (EC, KEB, PNJ, JLM), University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma
| | - Peter N Johnson
- Department of Pharmacy: Clinical and Administrative Sciences (EC, KEB, PNJ, JLM), University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma
| | - Raja Nandyal
- Section of Neonatology (RN), Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Jamie L Miller
- Department of Pharmacy: Clinical and Administrative Sciences (EC, KEB, PNJ, JLM), University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma
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Van Mechelen K, van Westering-Kroon E, Hütten M, Mahieu L, Villamor E. Placing Ureaplasma within the Context of Bronchopulmonary Dysplasia Endotypes and Phenotypes. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020256. [PMID: 36832386 PMCID: PMC9955705 DOI: 10.3390/children10020256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 02/03/2023]
Abstract
Different pathophysiological pathways (endotypes), leading to very preterm birth may result in distinct clinical phenotypes of bronchopulmonary dysplasia (BPD). Ureaplasma is a unique player in the pathogenesis of BPD. The interaction between factors inherent to Ureaplasma (virulence, bacterial load, duration of exposure), and to the host (immune response, infection clearance, degree of prematurity, respiratory support, concomitant infections) may contribute to BPD development in a variable manner. The data reviewed herein support the hypothesis that Ureaplasma, as a representative of the infectious/inflammatory endotype, may produce pulmonary damage predominantly in parenchyma, interstitium, and small airways. In contrast, Ureaplasma may have a very limited role in the pathogenesis of the vascular phenotype of BPD. In addition, if Ureaplasma is a key factor in BPD pathogenesis, its eradication by macrolides should prevent BPD. However, various meta-analyses do not show consistent evidence that this is the case. The limitations of current definitions and classifications of BPD, based on respiratory support needs instead of pathophysiology and phenotypes, may explain this and other failures in strategies aimed to prevent BPD. The precise mechanisms through which Ureaplasma infection leads to altered lung development and how these pathways can result in different BPD phenotypes warrant further investigation.
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Affiliation(s)
- Karen Van Mechelen
- Department of Pediatrics, Maastricht University Medical Center, School for Oncology and Reproduction (GROW), Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Elke van Westering-Kroon
- Department of Pediatrics, Maastricht University Medical Center, School for Oncology and Reproduction (GROW), Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Matthias Hütten
- Department of Pediatrics, Maastricht University Medical Center, School for Oncology and Reproduction (GROW), Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Ludo Mahieu
- Department of Neonatology, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Eduardo Villamor
- Department of Pediatrics, Maastricht University Medical Center, School for Oncology and Reproduction (GROW), Maastricht University, 6229 HX Maastricht, The Netherlands
- Correspondence:
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Alrashedi MG, Ali AS, Ahmed OA, Ibrahim IM. Local Delivery of Azithromycin Nanoformulation Attenuated Acute Lung Injury in Mice. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27238293. [PMID: 36500388 PMCID: PMC9739299 DOI: 10.3390/molecules27238293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
Humanity has suffered from the coronavirus disease 2019 (COVID-19) pandemic over the past two years, which has left behind millions of deaths. Azithromycin (AZ), an antibiotic used for the treatment of several bacterial infections, has shown antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as well as against the dengue, Zika, Ebola, and influenza viruses. Additionally, AZ has shown beneficial effects in non-infective diseases such as cystic fibrosis and bronchiectasis. However, the systemic use of AZ in several diseases showed low efficacy and potential cardiac toxicity. The application of nanotechnology to formulate a lung delivery system of AZ could prove to be one of the solutions to overcome these drawbacks. Therefore, we aimed to evaluate the attenuation of acute lung injury in mice via the local delivery of an AZ nanoformulation. The hot emulsification-ultrasonication method was used to prepare nanostructured lipid carrier of AZ (AZ-NLC) pulmonary delivery systems. The developed formulation was evaluated and characterized in vitro and in vivo. The efficacy of the prepared formulation was tested in the bleomycin (BLM) -mice model for acute lung injury. AZ-NLC was given by the intratracheal (IT) route for 6 days at a dose of about one-eighth oral dose of AZ suspension. Samples of lung tissues were taken at the end of the experiment for immunological and histological assessments. AZ-NLC showed an average particle size of 453 nm, polydispersity index of 0.228 ± 0.07, zeta potential of -30 ± 0.21 mV, and a sustained release pattern after the initial 50% drug release within the first 2 h. BLM successfully induced a marked increase in pro-inflammatory markers and also induced histological changes in pulmonary tissues. All these alterations were significantly reversed by the concomitant administration of AZ-NLC (IT). Pulmonary delivery of AZ-NLC offered delivery of the drug locally to lung tissues. Its attenuation of lung tissue inflammation and histological injury induced by bleomycin was likely through the downregulation of the p53 gene and the modulation of Bcl-2 expression. This novel strategy could eventually improve the effectiveness and diminish the adverse drug reactions of AZ. Lung delivery could be a promising treatment for acute lung injury regardless of its cause. However, further work is needed to explore the stability of the formulation, its pharmacokinetics, and its safety.
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Affiliation(s)
- Mohsen G. Alrashedi
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Ministry of Health, Riyadh 12628, Saudi Arabia
| | - Ahmed Shaker Ali
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71515, Egypt
| | - Osama Abdelhakim Ahmed
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ibrahim M. Ibrahim
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Correspondence:
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Venditto VJ, Feola DJ. Delivering macrolide antibiotics to heal a broken heart - And other inflammatory conditions. Adv Drug Deliv Rev 2022; 184:114252. [PMID: 35367307 PMCID: PMC9063468 DOI: 10.1016/j.addr.2022.114252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/07/2022] [Accepted: 03/28/2022] [Indexed: 12/17/2022]
Abstract
Drug carriers to deliver macrolide antibiotics, such as azithromycin, show promise as antibacterial agents. Macrolide drug carriers have largely focused on improving the drug stability and pharmacokinetics, while reducing adverse reactions and improving antibacterial activity. Recently, macrolides have shown promise in treating inflammatory conditions by promoting a reparative effect and limiting detrimental pro-inflammatory responses, which shifts the immunologic setpoint from suppression to balance. While macrolide drug carriers have only recently been investigated for their ability to modulate immune responses, the previous strategies that deliver macrolides for antibacterial therapy provide a roadmap for repurposing the macrolide drug carriers for therapeutic interventions targeting inflammatory conditions. This review describes the antibacterial and immunomodulatory activity of macrolides, while assessing the past in vivo evaluation of drug carriers used to deliver macrolides with the intention of presenting a case for increased effort to translate macrolide drug carriers into the clinic.
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Gilfillan M, Bhandari V. Moving Bronchopulmonary Dysplasia Research from the Bedside to the Bench. Am J Physiol Lung Cell Mol Physiol 2022; 322:L804-L821. [PMID: 35437999 DOI: 10.1152/ajplung.00452.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although advances in the respiratory management of extremely preterm infants have led to improvements in survival, this progress has not yet extended to a reduction in the incidence of bronchopulmonary dysplasia (BPD). BPD is a complex multifactorial condition that primarily occurs due to disturbances in the regulation of normal pulmonary airspace and vascular development. Preterm birth and exposure to invasive mechanical ventilation also compromises large airway development, leading to significant morbidity and mortality. Although both predisposing and protective genetic and environmental factors have been frequently described in the clinical literature, these findings have had limited impact on the development of effective therapeutic strategies. This gap is likely because the molecular pathways that underlie these observations are yet not fully understood, limiting the ability of researchers to identify novel treatments that can preserve normal lung development and/or enhance cellular repair mechanisms. In this review article, we will outline various well-established clinical observations whilst identifying key knowledge gaps that need to be filled with carefully designed pre-clinical experiments. We will address these issues by discussing controversial topics in the pathophysiology, the pathology and the treatment of BPD, including an evaluation of existing animal models that have been used to answer important questions.
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Affiliation(s)
- Margaret Gilfillan
- Division of Neonatology, St. Christopher's Hospital for Children/Drexel University College of Medicine, Philadelphia, PA
| | - Vineet Bhandari
- Division of Neonatology, The Children's Regional Hospital at Cooper/Cooper Medical School of Rowan University, Camden, NJ
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Sakaria RP, Dhanireddy R. Pharmacotherapy in Bronchopulmonary Dysplasia: What Is the Evidence? Front Pediatr 2022; 10:820259. [PMID: 35356441 PMCID: PMC8959440 DOI: 10.3389/fped.2022.820259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Bronchopulmonary Dysplasia (BPD) is a multifactorial disease affecting over 35% of extremely preterm infants born each year. Despite the advances made in understanding the pathogenesis of this disease over the last five decades, BPD remains one of the major causes of morbidity and mortality in this population, and the incidence of the disease increases with decreasing gestational age. As inflammation is one of the key drivers in the pathogenesis, it has been targeted by majority of pharmacological and non-pharmacological methods to prevent BPD. Most extremely premature infants receive a myriad of medications during their stay in the neonatal intensive care unit in an effort to prevent or manage BPD, with corticosteroids, caffeine, and diuretics being the most commonly used medications. However, there is no consensus regarding their use and benefits in this population. This review summarizes the available literature regarding these medications and aims to provide neonatologists and neonatal providers with evidence-based recommendations.
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Affiliation(s)
- Rishika P. Sakaria
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ramasubbareddy Dhanireddy
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, United States
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12
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Razak A, Alshehri N. Azithromycin for preventing bronchopulmonary dysplasia in preterm infants: A systematic review and meta-analysis. Pediatr Pulmonol 2021; 56:957-966. [PMID: 33382534 DOI: 10.1002/ppul.25230] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 11/30/2020] [Accepted: 12/11/2020] [Indexed: 12/29/2022]
Abstract
CONTEXT Azithromycin has anti-Ureaplasma and anti-inflammatory properties that might help reduce lung injury in preterm infants. OBJECTIVE To test the efficacy and safety of prophylactic or therapeutic azithromycin in preventing bronchopulmonary dysplasia (BPD) in preterm infants with unknown or proven Ureaplasma status. METHODS We searched PubMed, Web of Science, and Cochrane Library until 13 September 2020. Two authors independently assessed the eligibility, risk of bias, and extracted the data. We performed a random-effects model meta-analysis to yield pooled relative risk (RR) or mean difference (MD) with 95% confidence interval (CI). We used the Cochrane GRADE methodology for summarizing the results. RESULTS We included five randomized clinical trials. The meta-analysis revealed no significant differences in BPD (RR, 0.92; 95% CI, 0.71, 1.19; low-quality evidence), death (RR, 0.75; 95% CI, 0.52, 1.10; low-quality evidence), and BPD or death (RR, 0.90; 95% CI, 0.74, 1.10; low-quality evidence). However, a significantly lower BPD or death (RR, 0.83; 95% CI, 0.70, 0.99) and a trend toward lower BPD (RR, 0.83; 95% CI, 0.66, 1.03) with azithromycin therapy was noted in Ureoplasma positive neonates. No differences in secondary outcomes were noted, except for significantly lower supplemental oxygen days with azithromycin (MD, -6.06; 95% CI, -7.40, -4.72; moderate-quality evidence). The test for subgroup differences between short (<7 days) and long (>7 days) course of azithromycin were nonsignificant for all the outcomes. CONCLUSION Low-quality evidence suggests azithromycin therapy reduces BPD or death in preterm infants with positive Ureoplasma, but not in all preterm infants.
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Affiliation(s)
- Abdul Razak
- Division of Neonatology, Department of Pediatrics, Princess Nourah Bint Abdulrahman University, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Norah Alshehri
- Division of Neonatology, Department of Pediatrics, Princess Nourah Bint Abdulrahman University, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
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13
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Schützt Azithromycin
beatmete Frühgeborene
vor inflammatorischen
Komplikationen? Z Geburtshilfe Neonatol 2020. [DOI: 10.1055/a-1288-6810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Die Pathogenese der bronchopulmonalen Dysplasie (BPD) ist vielfältig:
Außer der Unreife des Respirationstrakts scheinen insbesondere
inflammatorische pulmonale Veränderungen zu ihrer Entstehung
beizutragen. Da Makrolide neben ihrer antibiotischen Wirkung offenbar auch
antientzündliche und immunmodulatorische Effekte zeigen, stellt sich die
Frage, ob sich hier möglicherweise ein neues Therapiefenster
öffnet.
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