Maternal azithromycin therapy for Ureaplasma intraamniotic infection delays preterm delivery and reduces fetal lung injury in a primate model - 21/11/12
, Miles J. Novy, MD a, Drew W. Sadowsky, PhD a, Terry K. Morgan, MD, PhD b, Mary Long, PhD c, Ed Acosta, PharmD c, Lynn B. Duffy, MT d, Ken B. Waites, MD d
Reprints: Peta L. Grigsby, PhD, Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, 505 N.W. 185th Ave., Beaverton, OR 97006Résumé |
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 (107 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.
Le texte complet de cet article est disponible en PDF.Key words : antenatal antibiotic therapy, bronchopulmonary dysplasia/chronic lung disease, chorioamnionitis and mycoplasmas, fetal brain injury, preterm birth
Plan
| This work was supported by the following grants: National Institute of Child Health and Human Development, numbers R01 HD6159, K99/R00 HD055059/HD055053, and BIRCWH HD043488; National Institute of Allergy and Infectious Diseases, number R01 A1072577; and the Division of Program Coordination, Planning, and Strategic Initiatives, number 8P51 OD 011092-53 (formally RR00163). |
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| The authors report no conflict of interest. |
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| Cite this article as: Grigsby PL, Novy MJ, Sadowsky DW, et al. Maternal azithromycin therapy for Ureaplasma intraamniotic infection delays preterm delivery and reduces fetal lung injury in a primate model. Am J Obstet Gynecol 2012;207:475.e1-14. |
Vol 207 - N° 6
P. 475.e1-475.e14 - décembre 2012 Retour au numéro
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