title: Prevention of bacterial infections in the newborn by pre-delivery administration of azithromycin: Study protocol of a randomized efficacy trial.
abstract: BACKGROUND
  Neonatal deaths, estimated at approximately 4 million annually, now account for almost 40% of global mortality in children aged under-five. Bacterial sepsis is a leading cause of neonatal mortality. Assuming the mother is the main source for bacterial transmission to newborns, the primary objective of the trial is to determine the impact of one oral dose of azithromycin, given to women in labour, on the newborn's bacterial carriage in the nasopharynx. Secondary objectives include the impact of the intervention on bacterial colonization in the baby and the mother during the first month of life.
  
  
  METHODS
  This is a Phase III, double -blind, placebo controlled randomized clinical trial in which 830 women in labour were randomized to either a single dose of 2 g oral azithromycin or placebo (ratio 1:1). The trial included pregnant women in labour aged 18 to 45 years attending study health centres in the Western Gambia. A post-natal check of the mother and baby was conducted at the health centre by study clinicians before discharge and 8-10 days after delivery. Home follow up visits were conducted daily during the first week and then weekly until week 8 after delivery. Vaginal swabs and breast milk samples were collected from the mothers, and the pathogens Streptococcus pneumoniae, Group B Streptococcus (GBS) and Staphylococcus aureus were isolated from the study samples. For bacterial isolates, susceptibility pattern to azithromycin was determined using disk diffusion and E-test. Eye swabs were collected from newborns with eye discharge during the follow up period, and Chlamydial infection was assessed using molecular methods.
  
  
  CONCLUSIONS
  This is a proof-of-concept study to assess the impact of antibiotic preventive treatment of women during labour on bacterial infections in the newborn. If the trial confirms this hypothesis, the next step will be to assess the impact of this intervention on neonatal sepsis. The proposed intervention should be easily implementable in developing countries.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier--NCT01800942--First received: February 26, 2013.
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia. aroca@mrc.gm.|London School of Hygiene and Tropical Medicine, London, United Kingdom. aroca@mrc.gm.
authors.forename: Anna
authors.initials: A
authors.lastname: Roca
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia. coluwalana@mrc.gm.
authors.forename: Claire
authors.initials: C
authors.lastname: Oluwalana
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia. bcamara@mrc.gm.
authors.forename: Bully
authors.initials: B
authors.lastname: Camara
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia. ambojang@mrc.gm.
authors.forename: Abdoulie
authors.initials: A
authors.lastname: Bojang
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom. Sarah.Burr@lshtm.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Burr
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia. tim.davis@uwa.edu.au.
authors.forename: Timothy M E
authors.initials: TM
authors.lastname: Davis
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom. Robin.Bailey@lshtm.ac.uk.
authors.forename: Robin
authors.initials: R
authors.lastname: Bailey
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia. bkampmann@mrc.gm.
authors.forename: Beate
authors.initials: B
authors.lastname: Kampmann
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia. jmueller@mrc.gm.
authors.forename: Jenny
authors.initials: J
authors.lastname: Mueller
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom. christian.bottomley@lshtm.ac.uk.
authors.forename: Christian
authors.initials: C
authors.lastname: Bottomley
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia. udalessandro@mrc.gm.|London School of Hygiene and Tropical Medicine, London, United Kingdom. udalessandro@mrc.gm.
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017963:Azithromycin / Q000008:administration & dosage*; D036861:Delivery, Obstetric; D004311:Double-Blind Method; D005260:Female; D005714:Gambia; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008895:Milk, Human / Q000382:microbiology; D009666:Nose / Q000382:microbiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000517:prevention & control; D013292:Streptococcus agalactiae / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D014621:Vagina / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin