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Maternal and transplacental pharmacokinetics of azithromycin.
Am J Obstet Gynecol. 2003 Mar; 188(3):714-8.AJ

Abstract

OBJECTIVE

The purpose of this study was to characterize the pharmacokinetics of orally administered azithromycin in the term gravid woman.

STUDY DESIGN

Twenty women who were scheduled for elective cesarean delivery were enrolled prospectively and received 1 g of oral azithromycin at either 6, 12, 24, 72, or 168 hours before the operation. All women received spinal anesthesia, at which time a sample of cerebrospinal fluid was obtained for analysis. Maternal serum and urine were obtained immediately before the operation. Intraoperatively, samples of myometrium, maternal adipose tissue, placenta, amniotic fluid, and umbilical arterial and venous cord blood were obtained. Azithromycin levels were determined quantitatively with high-pressure liquid chromatography with electrochemical detection.

RESULTS

All participants tolerated the preoperative azithromycin without significant adverse reactions. Peak maternal serum azithromycin levels occurred within 6 hours of drug administration. Although high serum levels of azithromycin were reached early, a rapid decline in drug concentration was noted over the initial 24 hours after the drug administration (6-hour: 311 ng/mL; 24-hour: 63 ng/mL). In contrast, azithromycin levels in myometrial, adipose, and placental tissue were higher (>500 ng/mL) and sustained for up to 72 hours after administration. High urine levels of azithromycin (>5000 ng/mL) were noted similarly during the initial 72 hours after drug administration. Umbilical arterial and venous serum azithromycin levels were low (19-38 ng/mL) during the first 72 hours. Amniotic fluid levels were highest at 6 hours (151 ng/mL) and declined rapidly. Maternal cerebrospinal azithromycin concentrations were undetectable for all time points.

CONCLUSION

Azithromycin has a rapid serum half-life in the term gravid woman with a prolonged half-life and high-sustained antibiotic levels noted within myometrium, adipose, and placental tissue. Given the broad antimicrobial spectrum and placental penetration, azithromycin may have potential use for the treatment of perinatal infections.

Authors+Show Affiliations

Division of Maternal-Fetal Medicine, Department of Obstetrics/Gynecology, Center for Research in Women's Health, University of Alabama at Birmingham, 35249, USA. ramsey_patrick@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12634646

Citation

Ramsey, Patrick S., et al. "Maternal and Transplacental Pharmacokinetics of Azithromycin." American Journal of Obstetrics and Gynecology, vol. 188, no. 3, 2003, pp. 714-8.
Ramsey PS, Vaules MB, Vasdev GM, et al. Maternal and transplacental pharmacokinetics of azithromycin. Am J Obstet Gynecol. 2003;188(3):714-8.
Ramsey, P. S., Vaules, M. B., Vasdev, G. M., Andrews, W. W., & Ramin, K. D. (2003). Maternal and transplacental pharmacokinetics of azithromycin. American Journal of Obstetrics and Gynecology, 188(3), 714-8.
Ramsey PS, et al. Maternal and Transplacental Pharmacokinetics of Azithromycin. Am J Obstet Gynecol. 2003;188(3):714-8. PubMed PMID: 12634646.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maternal and transplacental pharmacokinetics of azithromycin. AU - Ramsey,Patrick S, AU - Vaules,Megan B, AU - Vasdev,Gurinder M, AU - Andrews,William W, AU - Ramin,Kirk D, PY - 2003/3/14/pubmed PY - 2003/4/26/medline PY - 2003/3/14/entrez SP - 714 EP - 8 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 188 IS - 3 N2 - OBJECTIVE: The purpose of this study was to characterize the pharmacokinetics of orally administered azithromycin in the term gravid woman. STUDY DESIGN: Twenty women who were scheduled for elective cesarean delivery were enrolled prospectively and received 1 g of oral azithromycin at either 6, 12, 24, 72, or 168 hours before the operation. All women received spinal anesthesia, at which time a sample of cerebrospinal fluid was obtained for analysis. Maternal serum and urine were obtained immediately before the operation. Intraoperatively, samples of myometrium, maternal adipose tissue, placenta, amniotic fluid, and umbilical arterial and venous cord blood were obtained. Azithromycin levels were determined quantitatively with high-pressure liquid chromatography with electrochemical detection. RESULTS: All participants tolerated the preoperative azithromycin without significant adverse reactions. Peak maternal serum azithromycin levels occurred within 6 hours of drug administration. Although high serum levels of azithromycin were reached early, a rapid decline in drug concentration was noted over the initial 24 hours after the drug administration (6-hour: 311 ng/mL; 24-hour: 63 ng/mL). In contrast, azithromycin levels in myometrial, adipose, and placental tissue were higher (>500 ng/mL) and sustained for up to 72 hours after administration. High urine levels of azithromycin (>5000 ng/mL) were noted similarly during the initial 72 hours after drug administration. Umbilical arterial and venous serum azithromycin levels were low (19-38 ng/mL) during the first 72 hours. Amniotic fluid levels were highest at 6 hours (151 ng/mL) and declined rapidly. Maternal cerebrospinal azithromycin concentrations were undetectable for all time points. CONCLUSION: Azithromycin has a rapid serum half-life in the term gravid woman with a prolonged half-life and high-sustained antibiotic levels noted within myometrium, adipose, and placental tissue. Given the broad antimicrobial spectrum and placental penetration, azithromycin may have potential use for the treatment of perinatal infections. SN - 0002-9378 UR - https://www.unboundmedicine.com/medline/citation/12634646/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002937802714713 DB - PRIME DP - Unbound Medicine ER -