The Role of Azithromycin to Achieve Early Remission and Relapse Reduction in Children with Primary Nephrotic Syndrome — Randomized Controlled Trial

Abstract

Introduction: Nephrotic Syndrome (NS) is a common kidney disorder in children, marked by various complications. The standard treatment involves corticosteroids, but their prolonged use can lead to side effects. To address this, researchers have explored the potential of Azithromycin (AZM), an antibiotic with immune-modulating properties, as an adjunct to corticosteroid therapy. Methods and materials: This prospective randomized controlled trial was conducted at the Department of Paediatric Nephrology, National Institute of Kidney Diseases & Urology, Sher-E-Bangla Nagar, Dhaka, from November 2019 to June 2021. The study enrolled children aged 1-12 years with primary nephrotic syndrome (NS) during their initial episode and relapse, totaling 108 patients who provided informed written consent from their parents. Results: Initial attack NS patients, mean time to achieve remission was significantly lower in group A (7.74±2.78 days) who received azithromycin and prednisolone then group B (11.11±3.32 days) who received only prednisolone. (p<0.001). Similarly, among relapse case of NS, mean time required for remission was significantly lower in group C (7.63±2.54 days), who received prednisolone and azithromycin than group D (9.19±2.70 days), who received prednisolone only (p<0.034). In initial attack NS patients, number of relapse was lower in group A (20.0%) than group B (48.0%). [P<0.021] Similarly, among relapse patients, number of relapse was lower in group C patients (38.4%) than group D patient (48.0%).[p< 0.492] Conclusion: This study explored the impact of azithromycin treatment on initial and relapse cases in children with primary Nephrotic Syndrome (NS), and concluded that adding azithromycin along with prednisolone provided a greater benefit.