Antibiotic Prophlaxis for High-risk Laboring Women in Low Income Countries
Study Details
Study Description
Brief Summary
This study, performed over a course of 3 years in 5 collaborating hospitals in Cameroon, Africa, will randomize 750 women in labor with prolonged rupture of membranes ≥ 8 hours or prolonged labor ≥ 18 hours to identical oral regimens of 1 gram of azithromycin, 1 gram of azithromycin+2 grams of amoxicillin or placebo. Women will be followed to ascertain maternal infectious outcomes and perinatal outcomes.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
Phase 4 |
Detailed Description
This 3-arm study is a large randomized clinical trial designed to evaluate the comparative effectiveness and safety of single dose oral azithromycin or combined azithromycin+amoxicillin compared to placebo for the prevention of peripartum infections and sepsis in laboring women. We have previously shown the effectiveness of azithromycin for extended spectrum antibiotic prophylaxis in addition to the standard cephalosporin alone for reduction of post-cesarean infections. In LICs, the fraction of maternal infection and sepsis from cesarean delivery is minimal. Therefore, it is necessary to evaluate strategies aimed at reducing these morbidities in women who have vaginal births. There is an increased risk of infection in women who have prolonged labor or prolonged rupture of membranes. Drawing from our findings with azithromycin-based extended antibiotic prophylaxis for cesarean delivery, we propose to adapt the intervention and evaluate a single oral dose of azithromycin (with or without oral amoxicillin) to prevent maternal peripartum infection and sepsis. This study, performed over a course of 3 years in 5 collaborating hospitals in Cameroon, Africa, will randomize 750 women in labor with prolonged rupture of membranes ≥ 8 hours or prolonged labor ≥18 hours to 1 gram of oral azithromycin, 1 gram of azithromycin+2 grams of amoxicillin, compared to usual care (placebo). Women will be followed to ascertain maternal infectious outcomes and perinatal outcomes.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: Azithromycin and amoxicillin placebo Patients in this arm will receive 1 gram oral azithromycin as a single dose and amoxicillin placebo. |
Drug: Azithromycin
Azithromycin tablet
Drug: Placebo
Placebo tablet
|
Experimental: Azithromycin + amoxicillin Patients in this arm will receive 1 gram oral azithromycin and 2 grams oral amoxicillin in a single dose. |
Drug: Azithromycin and amoxicillin
azithromycin and amoxicillin
Other Names:
|
Placebo Comparator: Usual Care This arm will consist of routine care at the clinical sites (which is usually no antibiotic). They will receive placebo (for azithromycin) and placebo (for amoxicillin) |
Drug: Placebo
Placebo tablet
|
Outcome Measures
Primary Outcome Measures
- Number of Participants Who Experienced Composite Peripartum Infection or Death [Up to 6 weeks after delivery]
Maternal peripartum infection including chorioamnionitis, endometritis, wound infection/abscess, sepsis, and death
Secondary Outcome Measures
- Number of Participants Who Experienced Pyelonephritis [Up to hospital discharge]
Other Infections
- Number of Participants Who Experienced Breast Infection [Up to 6 weeks after delivery]
Other infections
- Number of Participants Who Experienced Other Infection [up to 6 weeks after delivery]
Includes Hepatitis B, thyroid infection, vaginal infection, viral infection, leg cellulitis, unknown abdominal infection,malaria
- Number of Participants Who Experienced Fever [up to 6 weeks after delivery]
Any fever higher than 38C
- Number of Participants Who Experienced Hypothermia [up to 6 weeks after delivery]
Any hypothermia less than 36C
- Number of Participants Who Needed PP Antibiotic [up to 6 weeks after delivery]
Any postpartum antibiotic
- Number of Participants Who Experienced Transfusion [up to 6 weeks after delivery]
Blood transfusion
- Number of Participants Who Experienced Stillbirth [delivery]
Any stillbirth
- Length of Stay [up to 6 weeks postpartum]
Length of stay in days
- Number of Participants Who Experienced a Clinic Visit [up to 6 weeks after delivery]
Clinic visit after discharge
- Number of Participants Who Experienced a Maternal Readmission [up to 6 weeks after delivery]
Maternal readmission
Eligibility Criteria
Criteria
Inclusion Criteria:
- Women ≥ 37 weeks' viable singleton or twin gestation in labor planning a vaginal delivery with
-
Prolonged membrane rupture (≥8 hours) or
-
Prolonged labor (≥18 hours).
Exclusion Criteria:
-
Clinical chorioamnionitis or any other active bacterial infection (e.g. pyelonephritis, pneumonia, abscess) at time of randomization: because standard antibiotic therapy for these conditions may confound trial intervention.
-
Allergy to azithromycin or amoxicillin
-
Plan for cesarean delivery prior to enrollment
-
Fetal demise or major congenital anomaly: Major congenital anomalies may confound assessment of neonatal outcomes and every attempt will be made up front to exclude them from randomization. However, some unrecognized fetal anomalies may inevitably be randomized. These will not be excluded post-randomization from the primary (maternal outcome) analysis; they will be taken into consideration in the secondary analyses of neonatal outcomes.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Cameroon Baptist Convention Health Services | Bamenda | Cameroon |
Sponsors and Collaborators
- University of Alabama at Birmingham
- Merck Sharp & Dohme LLC
Investigators
- Principal Investigator: Alan Tita, MD, PhD, University of Alabama at Birmingham
Study Documents (Full-Text)
More Information
Publications
- ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery. American Society of Health-System Pharmacists. Am J Health Syst Pharm. 1999 Sep 15;56(18):1839-88. Review.
- Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999 Apr;27(2):97-132; quiz 133-4; discussion 96.
- Tita ATN, Boggess K, Saade G. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery. N Engl J Med. 2017 Jan 12;376(2):182. doi: 10.1056/NEJMc1614626.
- WHO. WHO recommendations for prevention and treatment of maternal peripartum infections. Sept 2015 http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/peripartum-infections-guidelines/en/
- CHI UAB MISP # 54628
Study Results
Participant Flow
Recruitment Details | |
---|---|
Pre-assignment Detail |
Arm/Group Title | Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care |
---|---|---|---|
Arm/Group Description | Patients in this arm will receive 1 gram oral azithromycin as a single dose and amoxicillin placebo. Azithromycin: Azithromycin tablet Placebo: Placebo tablet | Patients in this arm will receive 1 gram oral azithromycin and 2 grams oral amoxicillin in a single dose. Azithromycin and amoxicillin: azithromycin and amoxicillin | This arm will consist of routine care at the clinical sites (which is usually no antibiotic). They will receive placebo (for azithromycin) and placebo (for amoxicillin) Placebo: Placebo tablet |
Period Title: Overall Study | |||
STARTED | 253 | 253 | 250 |
COMPLETED | 253 | 253 | 250 |
NOT COMPLETED | 0 | 0 | 0 |
Baseline Characteristics
Arm/Group Title | Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care | Total |
---|---|---|---|---|
Arm/Group Description | Patients in this arm will receive 1 gram oral azithromycin as a single dose and amoxicillin placebo. Azithromycin: Azithromycin tablet Placebo: Placebo tablet | Patients in this arm will receive 1 gram oral azithromycin and 2 grams oral amoxicillin in a single dose. Azithromycin and amoxicillin: azithromycin and amoxicillin | This arm will consist of routine care at the clinical sites (which is usually no antibiotic). They will receive placebo (for azithromycin) and placebo (for amoxicillin) Placebo: Placebo tablet | Total of all reporting groups |
Overall Participants | 253 | 253 | 250 | 756 |
Age, Customized (years) [Mean (Standard Deviation) ] | ||||
Mean (Standard Deviation) [years] |
27.2
(5.3)
|
26.4
(5.6)
|
26.0
(5.3)
|
26.5
(5.4)
|
Sex: Female, Male (Count of Participants) | ||||
Female |
253
100%
|
253
100%
|
250
100%
|
756
100%
|
Male |
0
0%
|
0
0%
|
0
0%
|
0
0%
|
Ethnicity (NIH/OMB) (Count of Participants) | ||||
Hispanic or Latino |
0
0%
|
0
0%
|
0
0%
|
0
0%
|
Not Hispanic or Latino |
253
100%
|
253
100%
|
250
100%
|
756
100%
|
Unknown or Not Reported |
0
0%
|
0
0%
|
0
0%
|
0
0%
|
Race (NIH/OMB) (Count of Participants) | ||||
American Indian or Alaska Native |
0
0%
|
0
0%
|
0
0%
|
0
0%
|
Asian |
0
0%
|
0
0%
|
0
0%
|
0
0%
|
Native Hawaiian or Other Pacific Islander |
0
0%
|
0
0%
|
0
0%
|
0
0%
|
Black or African American |
253
100%
|
253
100%
|
250
100%
|
756
100%
|
White |
0
0%
|
0
0%
|
0
0%
|
0
0%
|
More than one race |
0
0%
|
0
0%
|
0
0%
|
0
0%
|
Unknown or Not Reported |
0
0%
|
0
0%
|
0
0%
|
0
0%
|
Gestational age at Randomization (Weeks) [Mean (Standard Deviation) ] | ||||
Mean (Standard Deviation) [Weeks] |
39.4
(1.5)
|
39.2
(1.4)
|
39.2
(1.4)
|
39.3
(1.4)
|
Outcome Measures
Title | Number of Participants Who Experienced Composite Peripartum Infection or Death |
---|---|
Description | Maternal peripartum infection including chorioamnionitis, endometritis, wound infection/abscess, sepsis, and death |
Time Frame | Up to 6 weeks after delivery |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care |
---|---|---|---|
Arm/Group Description | Patients in this arm will receive 1 gram oral azithromycin as a single dose and amoxicillin placebo. Azithromycin: Azithromycin tablet Placebo: Placebo tablet | Patients in this arm will receive 1 gram oral azithromycin and 2 grams oral amoxicillin in a single dose. Azithromycin and amoxicillin: azithromycin and amoxicillin | This arm will consist of routine care at the clinical sites (which is usually no antibiotic). They will receive placebo (for azithromycin) and placebo (for amoxicillin) Placebo: Placebo tablet |
Measure Participants | 253 | 253 | 250 |
Count of Participants [Participants] |
15
5.9%
|
17
6.7%
|
24
9.6%
|
Title | Number of Participants Who Experienced Pyelonephritis |
---|---|
Description | Other Infections |
Time Frame | Up to hospital discharge |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care |
---|---|---|---|
Arm/Group Description | Patients in this arm will receive 1 gram oral azithromycin as a single dose and amoxicillin placebo. Azithromycin: Azithromycin tablet Placebo: Placebo tablet | Patients in this arm will receive 1 gram oral azithromycin and 2 grams oral amoxicillin in a single dose. Azithromycin and amoxicillin: azithromycin and amoxicillin | This arm will consist of routine care at the clinical sites (which is usually no antibiotic). They will receive placebo (for azithromycin) and placebo (for amoxicillin) Placebo: Placebo tablet |
Measure Participants | 253 | 253 | 250 |
Count of Participants [Participants] |
2
0.8%
|
2
0.8%
|
3
1.2%
|
Title | Number of Participants Who Experienced Breast Infection |
---|---|
Description | Other infections |
Time Frame | Up to 6 weeks after delivery |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care |
---|---|---|---|
Arm/Group Description | Patients in this arm will receive 1 gram oral azithromycin as a single dose and amoxicillin placebo. Azithromycin: Azithromycin tablet Placebo: Placebo tablet | Patients in this arm will receive 1 gram oral azithromycin and 2 grams oral amoxicillin in a single dose. Azithromycin and amoxicillin: azithromycin and amoxicillin | This arm will consist of routine care at the clinical sites (which is usually no antibiotic). They will receive placebo (for azithromycin) and placebo (for amoxicillin) Placebo: Placebo tablet |
Measure Participants | 253 | 253 | 250 |
Count of Participants [Participants] |
2
0.8%
|
0
0%
|
0
0%
|
Title | Number of Participants Who Experienced Other Infection |
---|---|
Description | Includes Hepatitis B, thyroid infection, vaginal infection, viral infection, leg cellulitis, unknown abdominal infection,malaria |
Time Frame | up to 6 weeks after delivery |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care |
---|---|---|---|
Arm/Group Description | Patients in this arm will receive 1 gram oral azithromycin as a single dose and amoxicillin placebo. Azithromycin: Azithromycin tablet Placebo: Placebo tablet | Patients in this arm will receive 1 gram oral azithromycin and 2 grams oral amoxicillin in a single dose. Azithromycin and amoxicillin: azithromycin and amoxicillin | This arm will consist of routine care at the clinical sites (which is usually no antibiotic). They will receive placebo (for azithromycin) and placebo (for amoxicillin) Placebo: Placebo tablet |
Measure Participants | 253 | 253 | 250 |
Count of Participants [Participants] |
4
1.6%
|
3
1.2%
|
1
0.4%
|
Title | Number of Participants Who Experienced Fever |
---|---|
Description | Any fever higher than 38C |
Time Frame | up to 6 weeks after delivery |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care |
---|---|---|---|
Arm/Group Description | Patients in this arm will receive 1 gram oral azithromycin as a single dose and amoxicillin placebo. Azithromycin: Azithromycin tablet Placebo: Placebo tablet | Patients in this arm will receive 1 gram oral azithromycin and 2 grams oral amoxicillin in a single dose. Azithromycin and amoxicillin: azithromycin and amoxicillin | This arm will consist of routine care at the clinical sites (which is usually no antibiotic). They will receive placebo (for azithromycin) and placebo (for amoxicillin) Placebo: Placebo tablet |
Measure Participants | 253 | 253 | 250 |
Count of Participants [Participants] |
22
8.7%
|
21
8.3%
|
28
11.2%
|
Title | Number of Participants Who Experienced Hypothermia |
---|---|
Description | Any hypothermia less than 36C |
Time Frame | up to 6 weeks after delivery |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care |
---|---|---|---|
Arm/Group Description | Patients in this arm will receive 1 gram oral azithromycin as a single dose and amoxicillin placebo. Azithromycin: Azithromycin tablet Placebo: Placebo tablet | Patients in this arm will receive 1 gram oral azithromycin and 2 grams oral amoxicillin in a single dose. Azithromycin and amoxicillin: azithromycin and amoxicillin | This arm will consist of routine care at the clinical sites (which is usually no antibiotic). They will receive placebo (for azithromycin) and placebo (for amoxicillin) Placebo: Placebo tablet |
Measure Participants | 253 | 253 | 250 |
Count of Participants [Participants] |
9
3.6%
|
11
4.3%
|
15
6%
|
Title | Number of Participants Who Needed PP Antibiotic |
---|---|
Description | Any postpartum antibiotic |
Time Frame | up to 6 weeks after delivery |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care |
---|---|---|---|
Arm/Group Description | Patients in this arm will receive 1 gram oral azithromycin as a single dose and amoxicillin placebo. Azithromycin: Azithromycin tablet Placebo: Placebo tablet | Patients in this arm will receive 1 gram oral azithromycin and 2 grams oral amoxicillin in a single dose. Azithromycin and amoxicillin: azithromycin and amoxicillin | This arm will consist of routine care at the clinical sites (which is usually no antibiotic). They will receive placebo (for azithromycin) and placebo (for amoxicillin) Placebo: Placebo tablet |
Measure Participants | 253 | 253 | 250 |
Count of Participants [Participants] |
18
7.1%
|
18
7.1%
|
26
10.4%
|
Title | Number of Participants Who Experienced Transfusion |
---|---|
Description | Blood transfusion |
Time Frame | up to 6 weeks after delivery |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care |
---|---|---|---|
Arm/Group Description | Patients in this arm will receive 1 gram oral azithromycin as a single dose and amoxicillin placebo. Azithromycin: Azithromycin tablet Placebo: Placebo tablet | Patients in this arm will receive 1 gram oral azithromycin and 2 grams oral amoxicillin in a single dose. Azithromycin and amoxicillin: azithromycin and amoxicillin | This arm will consist of routine care at the clinical sites (which is usually no antibiotic). They will receive placebo (for azithromycin) and placebo (for amoxicillin) Placebo: Placebo tablet |
Measure Participants | 253 | 253 | 250 |
Count of Participants [Participants] |
8
3.2%
|
3
1.2%
|
4
1.6%
|
Title | Number of Participants Who Experienced Stillbirth |
---|---|
Description | Any stillbirth |
Time Frame | delivery |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care |
---|---|---|---|
Arm/Group Description | Patients in this arm will receive 1 gram oral azithromycin as a single dose and amoxicillin placebo. Azithromycin: Azithromycin tablet Placebo: Placebo tablet | Patients in this arm will receive 1 gram oral azithromycin and 2 grams oral amoxicillin in a single dose. Azithromycin and amoxicillin: azithromycin and amoxicillin | This arm will consist of routine care at the clinical sites (which is usually no antibiotic). They will receive placebo (for azithromycin) and placebo (for amoxicillin) Placebo: Placebo tablet |
Measure Participants | 253 | 253 | 250 |
Count of Participants [Participants] |
1
0.4%
|
0
0%
|
1
0.4%
|
Title | Length of Stay |
---|---|
Description | Length of stay in days |
Time Frame | up to 6 weeks postpartum |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care |
---|---|---|---|
Arm/Group Description | Patients in this arm will receive 1 gram oral azithromycin as a single dose and amoxicillin placebo. Azithromycin: Azithromycin tablet Placebo: Placebo tablet | Patients in this arm will receive 1 gram oral azithromycin and 2 grams oral amoxicillin in a single dose. Azithromycin and amoxicillin: azithromycin and amoxicillin | This arm will consist of routine care at the clinical sites (which is usually no antibiotic). They will receive placebo (for azithromycin) and placebo (for amoxicillin) Placebo: Placebo tablet |
Measure Participants | 253 | 253 | 250 |
Mean (Standard Deviation) [days] |
3.7
(2.0)
|
3.7
(2.2)
|
3.8
(3.1)
|
Title | Number of Participants Who Experienced a Clinic Visit |
---|---|
Description | Clinic visit after discharge |
Time Frame | up to 6 weeks after delivery |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care |
---|---|---|---|
Arm/Group Description | Patients in this arm will receive 1 gram oral azithromycin as a single dose and amoxicillin placebo. Azithromycin: Azithromycin tablet Placebo: Placebo tablet | Patients in this arm will receive 1 gram oral azithromycin and 2 grams oral amoxicillin in a single dose. Azithromycin and amoxicillin: azithromycin and amoxicillin | This arm will consist of routine care at the clinical sites (which is usually no antibiotic). They will receive placebo (for azithromycin) and placebo (for amoxicillin) Placebo: Placebo tablet |
Measure Participants | 253 | 253 | 250 |
Count of Participants [Participants] |
13
5.1%
|
7
2.8%
|
10
4%
|
Title | Number of Participants Who Experienced a Maternal Readmission |
---|---|
Description | Maternal readmission |
Time Frame | up to 6 weeks after delivery |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care |
---|---|---|---|
Arm/Group Description | Patients in this arm will receive 1 gram oral azithromycin as a single dose and amoxicillin placebo. Azithromycin: Azithromycin tablet Placebo: Placebo tablet | Patients in this arm will receive 1 gram oral azithromycin and 2 grams oral amoxicillin in a single dose. Azithromycin and amoxicillin: azithromycin and amoxicillin | This arm will consist of routine care at the clinical sites (which is usually no antibiotic). They will receive placebo (for azithromycin) and placebo (for amoxicillin) Placebo: Placebo tablet |
Measure Participants | 253 | 253 | 250 |
Count of Participants [Participants] |
11
4.3%
|
4
1.6%
|
5
2%
|
Adverse Events
Time Frame | up to 6 weeks after delivery | |||||
---|---|---|---|---|---|---|
Adverse Event Reporting Description | ||||||
Arm/Group Title | Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care | |||
Arm/Group Description | Patients in this arm will receive 1 gram oral azithromycin as a single dose and amoxicillin placebo. Azithromycin: Azithromycin tablet Placebo: Placebo tablet | Patients in this arm will receive 1 gram oral azithromycin and 2 grams oral amoxicillin in a single dose. Azithromycin and amoxicillin: azithromycin and amoxicillin | This arm will consist of routine care at the clinical sites (which is usually no antibiotic). They will receive placebo (for azithromycin) and placebo (for amoxicillin) Placebo: Placebo tablet | |||
All Cause Mortality |
||||||
Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care | ||||
Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
Total | 0/253 (0%) | 0/253 (0%) | 0/250 (0%) | |||
Serious Adverse Events |
||||||
Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care | ||||
Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
Total | 0/253 (0%) | 0/253 (0%) | 0/250 (0%) | |||
Other (Not Including Serious) Adverse Events |
||||||
Azithromycin and Amoxicillin Placebo | Azithromycin + Amoxicillin | Usual Care | ||||
Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
Total | 0/253 (0%) | 0/253 (0%) | 0/250 (0%) |
Limitations/Caveats
More Information
Certain Agreements
Principal Investigators are NOT employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
Name/Title | Alan Tita, MD |
---|---|
Organization | University of Alabama at Birmingham |
Phone | 205-934-5612 |
atita@uab.edu |
- CHI UAB MISP # 54628