Azithromycin for Prevention of Bronchopulmonary Dysplasia and Other Neonatal Adverse Outcomes in Preterm Infants: An Updated Systematic Review and Meta-Analysis.

Azithromycin with its antimicrobial and anti-inflammatory properties has been explored as a potential option for preventing bronchopulmonary dysplasia (BPD) in preterm infants. We performed a meta-analysis of randomized controlled trials (RCTs) comparing azithromycin with placebo for the prevention of BPD in preterm infants. PubMed, Scopus, ClinicalTrials.gov, and Cochrane Central databases were searched for studies comparing azithromycin versus placebo in preterm infants. Outcomes of interest included the composite of bronchopulmonary dysplasia (BPD) and death, BPD, death, Grade 2 or higher necrotizing enterocolitis (NEC), Grade 3 or 4 intraventricular hemorrhage (IVH), retinopathy of prematurity (RoP), duration of mechanical ventilation, and postnatal corticosteroid requirement. Random effects model was used to generate risk ratio (RR), mean difference (MD), and 95% confidence interval (CI). (CRD42024558752). The meta-analysis included 6 RCTs including 1,360 infants (azithromycin n=680, 50%). The composite of BPD or death (RR 0.95; 95%CI 0.83-1.10; p=0.53; I2=50.2%), BPD (RR 0.98; 95%CI 0.83-1.15; p=0.77; I2=38.1%), death (RR 0.88; 95%CI 0.66-1.19; p=0.41; I2=0%), NEC (RR 0.94; 95%CI 0.69-1.26; p=0.67; I2=0%), IVH (RR 1.22; 95%CI 0.89-1.68; p=0.22; I2=3.5%), RoP (RR 1.35; 95%CI 0.43-4.28; p=0.61; I2=76.3%), duration of mechanical ventilation (MD 0.13; 95%CI -1.35 to 1.60; p=0.87; I2=0%), and postnatal corticosteroid requirement (RR 0.84; 95%CI 0.64-1.08; p=0.18; I2=34.5%) were similar between the groups. In preterm infants, azithromycin did not significantly change the risk of adverse clinical outcomes compared with placebo.