Antibiotics for Preterm Rupture of Membranes

A Cochrane review [Abstract] 1 included 22 trials involving over 6 800 women and their babies. The use of antibiotics following preterm rupture of membranes (PROM) showed a reduction in chorioamnionitis (RR 0.66, 95% CI 0.46 to 0.96, n=1 559). There was a reduction in the numbers of babies born within 48 hours (RR 0.71, 95% CI 0.58 to 0.87, I² =50%; n=5 927) and seven days (RR 0.79, 95% CI 0.71 to 0.89; statistical heterogeneity I² =65%). Neonatal morbidity was reduced: neonatal infection (RR 0.67, 95% CI 0.52 to 0.85, n=1 680), use of surfactant (RR 0.83, 95% CI 0.72 to 0.96, n=4 809), oxygen therapy (RR 0.88, 95% CI 0.81 to 0.96, n=4 809), and abnormal cerebral ultrasound scan prior to discharge from hospital (RR 0.81, 95% CI 0.68 to 0.98, n=6 289). Several antibiotics were used includin penicillins, beta lactams, and macrolides. Amoxicillin plus clavulanic acid was associated with an increased risk of neonatal necrotising enterocolitis (RR 4.72, 95% CI 1.57 to 14.23, n=1 880). No statistically significant reduction in perinatal mortality prior to discharge from hospital could be found (RR 0.87, 95% CI 0.72 to 1.05; n=6 982).One study evaluated the children's health at seven years of age (ORACLE Children Study) and found antibiotics seemed to have little effect on the health of children (RR 1.01, 95% CI 0.91 to 1.12; n=3 171).

A multicenter, retrospective analysis 2 included a cohort of women (453) with singleton pregnancies with confirmed rupture of membranes between 23 and 34 weeks. 78 patients received azithromycin for 1 day, 191 patients received azithromycin for 5 days, 52 patients received azithromycin for 7 days, and 132 patients received erythromycin. There was no statistical difference in median latency time of azithromycin 1 day (4.9 days, 95% CI 3.3 to 6.4), azithromycin 5 days (5.0, 95% CI 3.9 to 6.1), or azithromycin 7 days (4.9 days, 95% CI 2.8 to 7.0) when compared with erythromycin (5.1 days, 95% CI 3.9 to 6.4) after adjusting for demographic variables (P = .99). Clinical chorioamnionitis was not different between groups in the adjusted model. Respiratory distress syndrome was increased in the azithromycin 5 day group vs azithromycin 1 day vs erythromycin (44% vs. 29% and 29%, P = .005, respectively).

The following decision support rules contain links to this evidence summary:

• Antibiotics for preterm rupture of membranes http://www.ebmeds.org/ebmeds/ebmeds_home.asp?mode=scripts&submode=view&id=scr00590&country=UK

References

• Kenyon S, Boulvain M, Neilson JP. Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev 2013;(12):CD001058. [PubMed]
• Navathe R, Schoen CN, Heidari P et al. Azithromycin vs erythromycin for the management of preterm premature rupture of membranes. Am J Obstet Gynecol 2019;221(2):144.e1-144.e8. [PubMed]