Abstract
BackgroundVertical transmission can result in neonatal infection and disease. Reducing the transmission of bacterial pathogens from mother to infant may be an effective means of preventing neonatal infection, including bacterial conjunctivitis.MethodsIn a double-blind, randomized trial, we assessed the effect of administering a single dose of oral azithromycin to women in labour on bacterial colonization of the neonate. A reduction in purulent neonatal conjunctivitis was a secondary objective of the trial. Ocular samples were collected from the lower fornix of infants presenting with clinical signs of purulent conjunctivitis during the first eight weeks of life. Incidence of purulent conjunctivitis was compared between trial arms. Bacterial infection was assessed using PCR and incidence of purulent conjunctivitis due to bacteria was also compared between arms.ResultsForty of 843 infants (4.7%) presented clinical signs of purulent conjunctivitis. No significant difference in incidence of purulent conjunctivitis was seen between azithromycin and placebo arms [4.3% (18/419) versus 5.2% (22/424), OR = 0.82, 95% CI (0.44,1.54), p = 0.628]. S. aureus was the most commonly identified pathogen, detected in 38% of cases. Incidence of purulent-conjunctivitis due to bacterial infection was lower in the azithromycin arm [1.2% (5/419) versus 3.8% (16/424), OR = 0.31, 95% CI (0.12–0.82), p = 0.025)]. The incidence of gram-positive bacteria was also lower in the azithromycin arm [1.0% (4/419) versus 3.3% (14/424), OR = 0.28, 95%CI (0.10–0.82), p = 0.029].ConclusionsOral azithromycin given to women during labour may have the potential to reduce the incidence of bacterial neonatal conjunctivitis.Trial registrationClinicalTrials.gov, identifier NCT01800942, registration date 26 Feb 2013.
Highlights
Vertical transmission can result in neonatal infection and disease
Ocular bacterial infection in neonates often results from vertical transmission, from mother to child, during delivery
No difference was seen in the numbers of infants presenting with purulent conjunctivitis in the azithromycin (4.3%, 18/ 419) versus placebo (5.2%, 22/424) arm [OR = 0.82, 95%CI (0.44–1.54), p = 0.628] (Table 2)
Summary
Vertical transmission can result in neonatal infection and disease. Reducing the transmission of bacterial pathogens from mother to infant may be an effective means of preventing neonatal infection, including bacterial conjunctivitis. Ocular bacterial infection in neonates often results from vertical transmission, from mother to child, during delivery. Prenatal screening and treatment of expectant mothers is an effective means of preventing neonatal infection [1, 2]. Because bacterial conjunctivitis can give rise to complications including corneal ulceration, Vertical transmission during delivery can result in invasive disease, including neonatal sepsis, which is an important cause of death in this age group [4]. As asymptomatic carriage precedes bacterial invasion, interventions aimed at reducing carriage may provide an effective means of preventing disease. Prenatal screening for group B streptococcus and the administration of intravenous antibiotics during labour have greatly
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