Azithromycin for acute Q fever in pregnancy

Cerar, Daša; Karner, Primož; Avšič-Županc, Tatjana; Strle, Franc

doi:10.1007/s00508-009-1180-0

Cited by 9 publications

(3 citation statements)

References 22 publications

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“…However, C. burnetii can be definitely treated with doxycycline after delivery. Other authors have reported successful treatment (uneventful pregnancies) with azithromycin [31] or erythromycin and rifampicin [32].…”

Section: Coxiellamentioning

confidence: 99%

Intracellular bacteria and adverse pregnancy outcomes

Baud

Greub

2011

Clinical Microbiology and Infection

107

102

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This review considers the role of intracellular bacteria in adverse pregnancy outcomes, such as miscarriage, stillbirths, and preterm labour. The cause of miscarriage, stillbirth and preterm labour often remains unexplained. Intracellular bacteria that grow either poorly or not at all on media used routinely to detect human pathogens could be the aetiological agents of these obstetric conditions. For example, Listeria monocytogenes and Coxiella burnetti are intracellular bacteria that have a predilection for the fetomaternal unit and may induce fatal disease in the mother and/or fetus. Both are important foodborne or zoonotic pathogens in pregnancy. Preventive measures, diagnostic tools and treatment will be reviewed. Moreover, we will also address the importance in adverse pregnancy outcomes of other intracellular bacteria, including Brucella abortus and various members of the order Chlamydiales. Indeed, there is growing evidence that Chlamydia trachomatis, Chlamydia abortus and Chlamydia pneumoniae infections may also result in adverse pregnancy outcomes in humans and/or animals. Moreover, newly discovered Chlamydia-like organisms have recently emerged as new pathogens of both animals and humans. For example, Waddlia chondrophila, a Chlamydia-related bacterium isolated from aborted bovine fetuses, has also been implicated in human miscarriages. Future research should help us to better understand the pathophysiology of adverse pregnancy outcomes caused by intracellular bacteria and to determine the precise mode of transmission of newly identified bacteria, such as Waddlia and Parachlamydia. These emerging pathogens may represent the tip of the iceberg of a large number of as yet unknown intracellular pathogenic agents.

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Section: Coxiellamentioning

confidence: 99%

Intracellular bacteria and adverse pregnancy outcomes

Baud

Greub

2011

Clinical Microbiology and Infection

107

102

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“…Azithromycin (AZ) is a dibasic azalide class macrolide antibiotic commonly prescribed in pregnancy for treatment of chlamydia (15), scrub typhus (16), Q fever (17), and malaria (18) (in combination with chloroquinone). AZ is also active against the Ureaplasma spp.…”

mentioning

confidence: 99%

Maternal Intravenous Administration of Azithromycin Results in Significant Fetal Uptake in a Sheep Model of Second Trimester Pregnancy

Kemp

Miura

Payne

et al. 2014

Antimicrob Agents Chemother

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g Treatment of intrauterine infection is likely key to preventing a significant proportion of preterm deliveries before 32 weeks of gestation. Azithromycin (AZ) may be an effective antimicrobial in pregnancy; however, few gestation age-approriate data are available to inform the design of AZ-based treatment regimens in early pregnancy. We aimed to determine whether a single intra-amniotic AZ dose or repeated maternal intravenous (i.v.) AZ doses would safely yield therapeutic levels of AZ in an 80-daygestation (term is 150 days) ovine fetus. Fifty sheep carrying single pregnancies at 80 days gestation were randomized to receive either: (i) a single intra-amniotic AZ administration or (ii) maternal intravenous AZ administration every 12 h. Amniotic fluid, maternal plasma, and fetal AZ concentrations were determined over a 5-day treatment regimen. Markers of liver injury and amniotic fluid inflammation were measured to assess fetal injury in response to drug exposure. A single intra-amniotic administration yielded significant AZ accumulation in the amniotic fluid and fetal lung. In contrast, repeated maternal intravenous administrations achieved high levels of AZ accumulation in the fetal lung and liver and a statistically significant increase in the fetal plasma drug concentration at 120 h. There was no evidence of fetal injury in response to drug exposure. These data suggest that (i) repeated maternal i.v. AZ dosing yields substantial fetal tissue uptake, although fetal plasma drug levels remain low; (ii) transfer of AZ from the amniotic fluid is less than transplacental transfer; and (iii) exposure to high concentrations of AZ did not elicit overt changes in fetal white blood cell counts, amniotic fluid monocyte chemoattractant protein 1 concentrations, or hepatotoxicity, all consistent with an absence of fetal injury.

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“…Obstetric complications occur significantly more often as C. burnetii infects the patient at an early stage of her pregnancy (Carcopino et al, 2009). Although traditional treatment is with doxycycline, other drugs has also been used in pregnant women, such as azithromycin (Cerar et al, 2009) and cotrimoxazole, allowing the birth healthy babies (Carcopino et al, 2009). …”

Section: The Zoonosismentioning

confidence: 99%