BACKGROUNDS: Azithromycin mass drug administration (MDA) is a key part of the strategy for controlling trachoma. This systematic review aimed to comprehensively summarize the present studies of azithromycin MDA on trachoma; provide an overview of the impact of azithromycin MDA on trachoma in different districts; and explore the possible methods to enhance the effectiveness of azithromycin MDA in hyperendemic districts. METHODS: PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov were searched up to February 2021 with no language restriction. Studies reporting the effect of azithromycin MDA on trachoma were included. Mathematical modeling studies, animal studies, case reports, and reviews were excluded. The trachomatous inflammation-follicular (TF) <5.0% was used to judge the effect of azithromycin MDA on eliminating trachoma as a public health problem. Two researchers independently conducted the selection process and risk of bias assessment. RESULTS: A total of 1543 studies were screened, of which 67 studies including 13 cluster-randomized controlled trials and 54 non-randomized studies were included. The effect of azithromycin MDA on trachoma was closely related to the baseline prevalence in districts. For the districts with baseline prevalence between 5.0% and 9.9%, a single round of MDA achieved a TF <5.0%. For the districts with baseline between 10.0% and 29.9%, annual MDA for 3 to 5 years reduced TF <5.0%. However, for the districts with high level of baseline prevalence (TF >30.0%), especially with baseline TF >50.0%, annual MDA was unable to achieve the TF <5.0% even after 5 to 7 years of treatment. Quarterly MDA is more effective in controlling trachoma in these hyperendemic districts. CONCLUSIONS Azithromycin MDA for controlling trachoma depends on the baseline prevalence. The recommendation by the World Health Organization that annual MDA for 3 to 5 years in the districts with TF baseline >10.0% is not appropriate for all eligible districts.
Anti-Bacterial Agents/therapeutic use* ; Azithromycin/therapeutic use* ; Humans ; Infant ; Mass Drug Administration ; Prevalence ; Trachoma/epidemiology*

OBJECTIVE: To systematically evaluate the clinical effect of azithromycin (AZM) adjuvant therapy in children with bronchiolitis. METHODS: Related databases were searched for randomized controlled trials (RCTs) on AZM adjuvant therapy in children with bronchiolitis published up to February 17, 2019. RevMan 5.3 was used to perform the Meta analysis. RESULTS: A total of 14 RCTs were included, with 667 children in the intervention group and 651 in the control group. The pooled effect size showed that in the children with bronchiolitis, AZM adjuvant therapy did not shorten the length of hospital stay (MD=-0.29, 95%CI: -0.62 to 0.04, P=0.08) or oxygen supply time (MD=-0.33, 95%CI: -0.73 to 0.07, P=0.10), while it significantly shortened the time to the relief of wheezing (MD=-1.00, 95%CI: -1.72 to -0.28, P=0.007) and cough (MD=-0.48, 95%CI: -0.67 to -0.29, P<0.00001). The analysis of bacterial colonization revealed that AZM therapy significantly reduced the detection rates of Streptococcus pneumoniae (OR=0.24, 95%CI: 0.11-0.54, P=0.0006), Haemophilus (OR=0.28, 95%CI: 0.14-0.55, P=0.0002), and Moraxella catarrhalis (OR=0.21, 95%CI: 0.11-0.40, P<0.00001) in the nasopharyngeal region. CONCLUSIONS AZM adjuvant therapy can reduce the time to the relief of wheezing and cough in children with bronchiolitis, but it has no marked effect on the length of hospital stay and oxygen supply time.
Azithromycin ; therapeutic use ; Bronchiolitis ; drug therapy ; Child ; Combined Modality Therapy ; Humans ; Length of Stay ; Respiratory Sounds

To systematically review the effectiveness and safety of Reduning Injection in the treatment of acute tracheal-bronchitis.Four Chinese databases( CNKI,VIP,Wan Fang,Sino Med) and three English databases( Cochrane Library,Medline,Web of Science) were systematically and comprehensively retrieved. The retrieval time was from the establishment of each database to April 2019.Randomized controlled trials( RCTs) for the treatment of acute tracheal-bronchitis with Reduning Injection were collected. Two researchers independently conducted literature screening,data extraction and risk assessment for bias. Rev Man 5.3 software was used for data analysis. Fourteen studies were included,and the total sample size was 1 652 at last. Meta-analysis results show that in the aspect of total clinical effective rate,Reduning Injection was superior to ribavirin( RR = 1. 37,95%CI[1. 28,1. 47],P<0. 000 01); Reduning Injection combined with conventional therapy was better than conventional therapy alone( RR = 1. 14,95% CI[1. 09,1. 19],P <0. 000 01); Reduning Injection combined with azithromycin was better than azithromycin therapy alone( RR = 1. 21,95% CI[1. 07,1. 37],P = 0. 002). In the aspect of clinical symptoms,the time in average fever disappearance of Reduning Injection therapy was shorter than that of ribavirin therapy( MD =-1.68,95%CI[-1. 72,-1. 49],P<0. 000 01); the time in cough disappearance of Reduning Injection therapy was shorter than that of ribavirin therapy( MD =-2. 57,95%CI[-2. 91,-2. 24],P<0. 000 01); the time in lung rales disappearance,Reduning Injection therapy was superior to ribavirin therapy( MD =-2. 26,95% CI[-2. 71,-1. 80],P<0. 000 01),and Reduning Injection combined with conventional therapy was superior to conventional therapy( MD =-1. 77,95% CI[-1. 95,-1. 59],P<0. 000 01). Based on the findings,Reduning Injection can improve the total effective rate,reduce the average time of disappearance in fever,cough and lung rales,with mild adverse reactions and a low incidence. However,the quality of the literatures included is not high,it is necessary to adopt large-sample-size,rigorously designed clinical trial protocols in line with the international standards,in a bid to improve the quality of evidence.
Azithromycin/therapeutic use* ; Bronchitis/drug therapy* ; Drug Therapy, Combination ; Drugs, Chinese Herbal/therapeutic use* ; Humans ; Injections

Objective: To explore the effects of Zhibai Dihuang Decoction (ZDD) on mitochondrial cytochrome oxidase (COX) in the spermatogenic cells of rats with ureaplasma urealyticum (UU) infection. METHODS: From forty 4－5 months old SD rats, 30 were randomly selected for the establishment of the model of testicular UU infection by inoculating the bladder with UU suspension and the other 10 injected with normal saline as controls (group A). At 7 days after inoculation, the rat models of testicular UU infection were treated orally with normal saline (group B), ZDD at 1 g per kg of the body weight per day (group C), and azithromycin at 0.105 g per kg of the body weight per day (group D), respectively, once daily for 21 days. Then all the animals were sacrificed and the epididymal and testicular tissues collected for examination of sperm motility with the color sperm dynamic detection system, measurement of the COX activity with the immunohistochemical DAB method, and determination of the mRNA expressions of COXⅠ and COXⅡ by RT-PCR. RESULTS: Compared with group A, group B showed significant decreases in such sperm parameters as grade a sperm (［1.03 ± 0.09］ vs ［0.07 ± 0.03］ %, P<0.01), grade b sperm (［2.07 ± 0.52］ vs ［0.35 ± 0.13］ %, P<0.01), straight line velocity (VSL) (［10.95 ± 0.98］ vs ［6.78 ± 1.05］ μm/s, P<0.01), curvilinear velocity (VCL) (［42.03 ± 1.35］ vs ［38.10 ± 7.65］ μm/s, P>0.05), average path velocity (VAP) (［16.22 ± 1.52］ vs ［10.05 ± 1.80］ μm/s, P<0.01), and the mRNA expressions of COX Ⅰ (［2.25 ± 0.24］ vs ［0.93 ± 0.10］ %, P<0.01) and Ⅱ (［6.72 ± 0.37］ vs ［2.95 ± 0.78］ %, P<0.01). After treatment, all the parameters were remarkably increased in groups C and D (grade a sperm: ［1.11 ± 0.30］ and ［0.60 ± 0.19］%; grade b sperm: ［2.40 ± 0.59］ and ［1.32 ± 0.27］ %; VSL: ［12.11 ± 1.62］ and ［11.47 ± 1.21］ μm/s; VCL: ［54.30 ± 2.35］ and ［45.75 ± 1.64］ μm/s; VAP ［18.40 ± 1.27］ and ［16.69 ± 1.02］ μm/s; expression of COXⅠ mRNA: ［1.86 ± 0.30］ and ［1.74 ± 0.17］ %) as compared with those in group B (P<0.05or P<0.01) except the COX activity and the expression of COX Ⅱ mRNA (P>0.05), and all the parameters were significantly higher in group C than in D (P<0.05or P<0.01). CONCLUSIONS UU infection can reduce grades a and b sperm, linear, curvilinear and mean sperm velocities, and the mRNA expressions of COX Ⅰ and Ⅱ while ZDD can improve these parameters. The improvement of sperm motility may not be associated with the activity of COX, and the COX activity may be related to the mRNA expression of COX II but not that of COXⅠ.
Animals ; Anti-Bacterial Agents ; therapeutic use ; Azithromycin ; therapeutic use ; Drugs, Chinese Herbal ; pharmacology ; Electron Transport Complex IV ; metabolism ; Epididymis ; drug effects ; enzymology ; Humans ; Male ; Mitochondria ; drug effects ; enzymology ; RNA, Messenger ; metabolism ; Rats ; Rats, Sprague-Dawley ; Sperm Motility ; Spermatozoa ; drug effects ; enzymology ; physiology ; Ureaplasma Infections ; drug therapy ; enzymology ; Ureaplasma urealyticum

OBJECTIVETo evaluate the therapeutic effects of antibacterial agents, glucocorticoid and intravenous immunoglobulin (IVIG) in treating Mycoplasma pneumoniae(MP) infections.

METHODThe literature was screened by the inclusion and exclusion criteria after searching at Cochrane Library, Pubmed, Wanfang, CNKI, and Weipu databases. According to JADAD evaluation system, the relevant information in each included report from the literature was evaluated. The evidence-based analysis was performed for the therapeutic effects of macrolides, glucocorticoid, and IVIG in treating MP infections. Meta-analysis was conducted on the suitable literature by RevMan 5.3 software supplied by Cochrane collaboration. Descriptive analysis was conducted on the literature unsuitable for meta-analysis.

RESULT(1) Seven foreign RCT reports and 7 domestic RCT reports were included in the analysis of the therapeutic effect of macrolides. There was a high heterogeneity among the 7 foreign reports. Five of these reports showed no significant difference in clinical effects between macrolides and non-macrolide antibacterial agents. The forest plot analysis of antipyretic timing and cough duration in the domestic literature with complete indicators suggested that for azithromycin sequential therapy vs. erythromycin intravenous therapy, the mean difference of antipyretic timing was-1.10 (95% CI: -1.60,-0.60) and the mean difference of cough duration was-1.56 (95% CI: -2.10,-1.03). (2) Three foreign RCT reports and 5 domestic RCT were included in the analysis of glucocorticoid therapy. The JADAD scores of all the reports were 1. The basic therapy drug was macrolides. The results of sub-group analysis suggested that for the patients who used glucocorticoid early vs. the patients who used non-glucocorticoid therapy, the mean difference of antipyretic time was-1.77(95% CI: -2.44,-1.10) and the mean difference of cough duration was-2.47 (95% CI: -2.86,-2.08); for the patients treated with glucocorticoid at 10 days after onset of diseases vs. the patients received non-glucocorticoid therapy, the mean difference of antipyretic time was-3.41 (95% CI: -4.10,-2.73) and the mean difference of cough duration was-2.25 (95%CI: -4.38,-0.12). (3) Regarding IVIG, all the included reports were case study or case report. Most of the literature focused on severe Mycoplasma pneumoniae infection and those with extrapulmonary complications. The limited results suggested a trend of the shortening of disease process and improvement of clinical symptoms by IVIG.

CONCLUSIONThere was no exact evidence of the therapeutic effects of antibacterial agents in Mycoplasma pneumoniae infections. A trend of better therapeutic effect was inferred in macrolide antibiotics, especially azithromycin. The improvement of clinical symptoms was suggested with the usage of glucocorticoid as adjuvant therapy. IVIG as an adjuvant therapy is at an exploration stage.

Anti-Bacterial Agents ; therapeutic use ; Azithromycin ; therapeutic use ; Child ; Cough ; Erythromycin ; therapeutic use ; Glucocorticoids ; therapeutic use ; Humans ; Immunoglobulins, Intravenous ; therapeutic use ; Macrolides ; therapeutic use ; Mycoplasma Infections ; drug therapy ; Mycoplasma pneumoniae ; Randomized Controlled Trials as Topic

BACKGROUNDAcute diarrhea remains the serious problem in developing countries, especially among children under 5 years of age. Currently, only two or three common diarrhea pathogens were screened at most hospitals in China. The aim of this study was to provide a wide variety of diarrhea pathogens and their antimicrobial resistance patterns in children under 5 years of age.

METHODSTotally 381 stool samples collected from Tongji Hospital between July 1, 2014 and June 30, 2015 were tested by culture and/or polymerase chain reaction for eight kinds of bacteria and five kinds of viruses. An antimicrobial sensitivity test was performed using dilution method recommended by the Clinical and Laboratory Standards Institute.

RESULTSViral infections were mainly identified in infants (0-11 months), whereas bacterial infections were more prevalent in the age of 24-59 months. About 69.8% of samples were positive for at least one pathogen, 51.7% of samples were virus positive, followed by bacteria positive cases (19.4%), and 12.6% of cases displayed co-infections with two viruses or a virus and a bacterium. Rotavirus was the most prevalent pathogen, followed closely by norovirus, while Salmonella was the most commonly isolated bacteria, followed by diarrheagenic Escherichia coli (DEC) and Campylobacter. More than 40% of Salmonella spp. and DEC isolates were resistant to first-line antibiotics (ampicillin, trimethoprim-sulfamethoxazole, and tetracycline). Around 10% of Salmonella spp. isolates were resistant to ceftriaxone and ciprofloxacin simultaneously. Campylobacter spp. displayed high resistance to ciprofloxacin but kept low resistance to azithromycin and doxycycline.

CONCLUSIONSThe etiology of acute diarrhea varies in children of different age groups. The high frequency of infection with viruses suggests the urgent demand for new viral vaccine development. Proper use of antibiotics in the treatment of acute diarrhea is crucial due to the high level of antibiotic resistance.

Acute Disease ; Anti-Bacterial Agents ; therapeutic use ; Azithromycin ; therapeutic use ; Campylobacter ; drug effects ; pathogenicity ; Child, Preschool ; China ; Ciprofloxacin ; therapeutic use ; Diarrhea ; drug therapy ; etiology ; microbiology ; virology ; Doxycycline ; therapeutic use ; Escherichia coli ; drug effects ; pathogenicity ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Salmonella ; drug effects ; pathogenicity

OBJECTIVETo evaluate the safety and effectiveness of a novel therapeutic regimen for bronchiolitis obliterans sydrome (BOS) affter hematopoietic stem cell transplantation (HSCT).

METHODSSeven patients who had received HSCT and had been diagnosed as BOS were enrolled in this study. They received weekly intravenous injection of umbilical cord-derived mesenchymal stem cells (MSC) at a dose of 1 × 10(6)/kg for 4 weeks. Budesonide was given orally at a daily dose of 0.25 g, and salmeterol was inhaled at a dose of 4.5 µg for 3 times per day. Methylprednisolone was given at a dose of 1 mg/(kg·d) for 2 weeks when respiratory failure occured. The dose of methylprednisolone was tapered to 0.25 mg/(kg·d) after 4 weeks and was adjusted according to the occurrence and severity of chronic graft-versus-host disease (cGVHD).

RESULTSThe therapy was generally safe and no severe acute toxicity was observed. One patient died of heart failure during the treatment, the other 6 patients were alive and the pulmonary function parameters including FEV1, FEV1/FVC, PaO2 and AaDO2 were significantly improved after 6 months as compared with the baseline parameters (P < 0.05).

CONCLUSIONMSC combined with budesonide, almeterol and azithromycin has been confirmed to be generally safe and can reduce the dose of glucocorticoid in treatment of BOS after HSCT.

Azithromycin ; therapeutic use ; Bronchiolitis Obliterans ; therapy ; Budesonide ; therapeutic use ; Combined Modality Therapy ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Humans ; Mesenchymal Stem Cell Transplantation ; Methylprednisolone ; administration & dosage ; therapeutic use ; Salmeterol Xinafoate ; therapeutic use

OBJECTIVETo evaluate the effectiveness and safety of azithromycin in treatment of bronchial asthma.

METHODSReports of randomized controlled trials (RCTs) describing azithromycin for treatment of asthma published before December 2013 were searched in CNKI, WANFANG, PubMed and Medline databases. The data of the included RCTs were extracted and the data quality was evaluated by two assessors independently. Meta-analyses were performed with Revman 5.1 software.

RESULTSEight RCTs were identified. Meta-analysis of the data showed that compared with the control group, azithromycin treatment significantly improved the patients' PEF (WMD=0.15, 95%CI=0.06-0.24, P=0.001), scores of asthma control test (ACT) (WMD=1.59, 95%CI=0.95-2.23, P<0.00001), and FEV1% (WMD=1.44, 95%CI=0.40-2.49, P=0.007), but the improvement of FEV1% was observed only in Chinese patients (WMD=1.48, 95%CI=0.40-2.57, P=0.007). The scores of asthma control questionnaire (WMD=0.07, 95%CI=-0.11-0.25, P=0.45) or asthma quality of life questionnaire (WMD=-0.06, 95%CI=-0.42-0.31, P=0.77) were not affected by azithromycin. No severe adverse events were reported in these included studies.

CONCLUSIONAzithromycin for asthma treatment can improve PEF, ACT and FEV1% (in Chinese patients only) but shows no significant effect on the quality of life of the patients. Azithromycin is well tolerated and may therefore be beneficial as adjuvant therapy for asthma.

Asthma ; drug therapy ; Azithromycin ; therapeutic use ; Humans ; Quality of Life ; Randomized Controlled Trials as Topic

Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Azithromycin ; therapeutic use ; Ceftriaxone ; therapeutic use ; Humans ; Levofloxacin ; therapeutic use ; Male ; Middle Aged ; Nitrofurantoin ; therapeutic use ; Urethra ; microbiology ; pathology ; Urethral Diseases ; drug therapy ; therapy ; Young Adult

Multidrug-resistant Salmonella is a well-recognised problem worldwide, especially in developing countries such as India, where non-typhoidal Salmonella infections and enteric fever are endemic. Antimicrobial resistance, particularly to fluoroquinolones, is common and leads to the frequent use of alternative agents, such as azithromycin. We herein describe the first reported case of azithromycin-resistant Salmonella gastroenteritis in a Singaporean patient.
Aged ; Anti-Bacterial Agents ; therapeutic use ; Azithromycin ; therapeutic use ; Drug Resistance, Bacterial ; Fluoroquinolones ; therapeutic use ; Gastroenteritis ; drug therapy ; microbiology ; Humans ; Male ; Microbial Sensitivity Tests ; Salmonella Infections ; drug therapy ; Salmonella enterica ; drug effects ; isolation & purification ; Singapore