Chen Zhe, Jiang Zhimei, Liu Dan, Wen Yan, Zeng Linan, Huang Liang, Shi Jing, Zhang Lingli
Sichuan University West China School of Pharmacy, Chengdu, Sichuan, China.
Department of Pharmacy/Evidence-Based Pharmacy Center, Sichuan University West China Second University Hospital; Children's Medicine Key Laboratory of Sichuan Province, Chengdu, Sichuan, China.
Arch Dis Child Fetal Neonatal Ed. 2025 Mar 5. doi: 10.1136/archdischild-2024-328220.
To evaluate the efficacy and safety of azithromycin in eradicating and preventing bronchopulmonary dysplasia (BPD) in preterm infants.
Six literature databases and three clinical trial registration platforms were searched for studies up to 22 July 2024. The meta-analysis was performed using RevMan V.5.3.
A total of 1723 preterm infants from 10 randomised controlled trials and 3 case series were included. In all preterm infants, azithromycin significantly improved clearance (relative risk (RR)=1.47, 95% CI 1.17 to 1.85) and reduced the duration of mechanical ventilation (mean difference (MD)=-2.16, 95% CI -2.65 to -1.68), duration of supplemental oxygen (MD=-5.46, 95% CI -6.65 to -4.37) and length of stay (MD=-4.98, 95% CI -7.19 to -2.76) compared with placebo; however, there was no significant reduction in BPD, BPD-death or mortality, with low quality of evidence. In -positive preterm infants, azithromycin significantly reduced BPD-death (RR=0.83, 95% CI 0.70 to 0.99) and mechanical ventilation (MD=-2.20, 95% CI -2.72 to -1.69), compared with placebo, and significantly increased clearance rate. Additionally, compared with erythromycin, azithromycin reduced BPD, without a statistically significant difference. Compared with placebo, azithromycin showed no statistically significant differences in the incidence of necrotising enterocolitis, retinopathy, intraventricular haemorrhage, etc. CONCLUSIONS: Low-quality evidence indicated prophylactic use of azithromycin could reduce the incidence of BPD-death and the duration of mechanical ventilation in -positive preterm infants. However, such benefits were not observed in all preterm infants. Meanwhile, azithromycin was found to be safe for administration in preterm infants.
CRD42024585836.
评估阿奇霉素在根除和预防早产儿支气管肺发育不良（BPD）方面的疗效和安全性。
检索了六个文献数据库和三个临床试验注册平台，以查找截至2024年7月22日的研究。使用RevMan V.5.3进行荟萃分析。
共纳入了来自10项随机对照试验和3个病例系列的1723例早产儿。在所有早产儿中，与安慰剂相比，阿奇霉素显著改善了清除率（相对危险度（RR）=1.47，95%可信区间1.17至1.85），并缩短了机械通气时间（平均差（MD）=-2.16，95%可信区间-2.65至-1.68）、补充氧气时间（MD=-5.46，95%可信区间-6.65至-4.37）和住院时间（MD=-4.98，95%可信区间-7.19至-2.76）；然而，在证据质量较低的情况下，BPD、BPD死亡或死亡率并无显著降低。在阳性早产儿中，与安慰剂相比，阿奇霉素显著降低了BPD死亡（RR=0.83，95%可信区间0.70至0.99）和机械通气时间（MD=-2.20，95%可信区间-2.72至-1.69），并显著提高了清除率。此外，与红霉素相比，阿奇霉素降低了BPD，但差异无统计学意义。与安慰剂相比，阿奇霉素在坏死性小肠结肠炎、视网膜病变、脑室内出血等的发生率方面无统计学显著差异。结论：低质量证据表明，预防性使用阿奇霉素可降低阳性早产儿BPD死亡的发生率和机械通气时间。然而，并非所有早产儿都观察到了这种益处。同时，发现阿奇霉素对早产儿给药是安全的。
PROSPERO注册号：CRD42024585836。
