Oral azithromycin given during labour decreases bacterial carriage in the mothers and their offspring: a double-blind randomized trial

Abstract

Bacterial sepsis remains a leading cause of death among neonates with Staphylococcus aureus, group B streptococcus (GBS) and Streptococcus pneumoniae identified as the most common causative pathogens in Africa. Asymptomatic bacterial colonization is an intermediate step towards sepsis. We conducted a phase III, double-blind, placebo-controlled randomized trial to determine the impact of giving one oral dose of azithromycin to Gambian women in labour on the nasopharyngeal carriage of S. aureus, GBS or S. pneumoniae in the newborn at day 6 postpartum. Study participants were recruited in a health facility in western Gambia. They were followed for 8 weeks and samples were collected during the first 4 weeks. Between April 2013 and April 2014 we recruited 829 women who delivered 843 babies, including 13 stillbirths. Sixteen babies died during the follow-up period. No maternal deaths were observed. No serious adverse events related to the intervention were reported. According to the intent-to-treat analysis, prevalence of nasopharyngeal carriage of the bacteria of interest in the newborns at day 6 was lower in the intervention arm (28.3% versus 65.1% prevalence ratio 0.43; 95% CI 0.36-0.52, p <0.001). At the same time-point, prevalence of any bacteria in the mother was also lower in the azithromycin group (nasopharynx, 9.3% versus 40.0%, p <0.001; breast milk, 7.9% versus 21.6%, p <0.001; and the vaginal tract, 13.2% versus 24.2%, p <0.001). Differences between arms lasted for at least 4 weeks. Oral azithromycin given to women in labour decreased the carriage of bacteria of interest in mothers and newborns and may lower the risk of neonatal sepsis. Trial registrationClinicalTrials.gov Identifier NCT01800942.

Keywords: Azithromycin; bacterial carriage; neonatal sepsis; randomized clinical trial; sub-Saharan Africa.

Fig. 1

Trial profile. Abbreviations: nb, Newborns; m, Mothers; NPSn, nasopharyngeal swabs collected from newborns; NPSm, nasopharyngeal swabs collected from mothers; BM, breast milk samples collected; VS, vaginal swabs collected. Some participants were still present until follow up but their samples were missed in some of the visits.

Fig. 2

Bacterial carriage of Staphylococcus aureus, group B streptococci (GBS) and Streptococcus pneumoniae in the different study time points for the azithromycin (AZI) and placebo groups. (a) Newborn nasopharyngeal swabs (NPS); (b) Maternal NPS; (c) Breast milk sample.