Azithromycin for the Prevention of Chronic Lung Disease of Prematurity: Not a Silver Bullet

Chronic lung disease of prematurity (CLD), often defined as the need for oxygen or positive pressure ventilation at 36 weeks post-menstrual age, is a significant concern among preterm infants, affecting nearly 50% of those born before 28 weeks gestation.1 Efforts to address CLD include exploring azithromycin as a potential therapy, supported by small randomised trials2,3 and systematic reviews.4 Azithromycin's effectiveness against Ureaplasma spp, a bacterial pathogen commonly found in the respiratory tracts of preterm infants which is associated with CLD,5 and its immunomodulatory properties6 suggest it might reduce the risk of CLD.