Randomized, placebo-controlled clinical trial of oral azithromycin prophylaxis against respiratory infections in a high-risk, young adult population.
Military Special Forces trainees undergo intense psychological and physical stressors that often lead to respiratory infection. During 1998-2000, 477 Navy Special Forces trainees were enrolled in a double-blind trial of oral azithromycin (1 g given weekly) plus a placebo injection, compared with benzathine penicillin G (1.2 million U) plus azithromycin placebo tablets. Among the 464 subjects with complete data, 44 developed acute respiratory infection (20 with pneumonia) during the 2 weeks of most intense training; of these subjects, 12 (27.3%) had evidence of Chlamydia pneumoniae infection and 7 (15.9%) had evidence of Mycoplasma pneumoniae infection. Trainees who received azithromycin were less likely than were trainees who received benzathine penicillin G to develop acute respiratory infection (risk ratio, 0.50; 95% confidence interval [CI], 0.28-0.92) and less likely at the end of training to report episodes of breathing difficulty (odds ratio [OR], 0.59; 95% CI, 0.34-1.01) or sore throat (OR, 0.66; 95% CI, 0.41-1.05). Compared with benzathine penicillin G prophylaxis, weekly oral azithromycin was superior in preventing respiratory infection in this population at transient high risk.
Gray
G C
GC
Department of Defense Center for Deployment Health Research, Naval Health Research Center, San Diego, CA 92186-5122, USA. Gregory-Gray@uiowa.edu
Witucki
P J
PJ
Gould
M T
MT
Bell
S J
SJ
Hiliopoulos
K M
KM
McKeehan
J A
JA
Fuller
J M
JM
Barrozo
C P
CP
Hudspeth
M K
MK
Smith
T C
TC
Ledbetter
E K
EK
Wallace
M R
MR
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D017963:Azithromycin / Q000008:administration & dosage / Q000627:therapeutic use*; D023521:Chlamydophila Infections / Q000382:microbiology / Q000517:prevention & control; D016993:Chlamydophila pneumoniae / Q000302:isolation & purification; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D008889:Military Personnel; D009177:Mycoplasma pneumoniae / Q000302:isolation & purification; D010401:Penicillin G Benzathine / Q000008:administration & dosage / Q000627:therapeutic use; D010406:Penicillins / Q000008:administration & dosage / Q000627:therapeutic use; D011019:Pneumonia, Mycoplasma / Q000382:microbiology / Q000517:prevention & control; D012141:Respiratory Tract Infections / Q000382:microbiology / Q000517:prevention & control*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D010406:Penicillins; D017963:Azithromycin; D010401:Penicillin G Benzathine