A Cochrane review «Antibiotics for preterm rupture of membranes»1 «Kenyon S, Boulvain M, Neilson JP. Antibiotics for ...»1 included 22 trials involving over 6800 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=1559). 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=5927) 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=4809), oxygen therapy (RR 0.88, 95% CI 0.81 to 0.96, n=4809), and abnormal cerebral ultrasound scan prior to discharge from hospital (RR 0.81, 95% CI 0.68 to 0.98, n=6289). 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=1880). 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=6982). 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=3171).
A multicenter, retrospective analysis «Navathe R, Schoen CN, Heidari P et al. Azithromyci...»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).
A systematic review and meta-analysis «...»3 estimating erythromycin vs azithromycin included 5 studies with 1289 women. The mean length of latency in women with preterm prelabor rupture of membranes was similar between individuals treated with erythromycin and those treated with azithromycin: 6.6 days vs 6.7 days (mean difference, 0.07 days; 95% cCI -0.45 to 0.60; I²=0%). The median point prevalence rates of clinical chorioamnionitis were 25% (95% CI 12 to 32) with erythromycin and 14% (95% CI 9 to 24) with azithromycin. The overall clinical chorioamnionitis rate in women treated with azithromycin was lower than women treated with erythromycin (pooled odds ratio, 0.53; 95% CI 0.39 to 0.71; I²=0%).
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