HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kenyon, S. Articles by Neilson, J. Search for Related Content PubMed PubMed Citation Articles by Kenyon, S. Articles by Neilson, J. Related Collections General obstetrics Obstetric complications of pregnancy Pediatrics/neonatology Preterm labor

Antibiotics for Preterm Rupture of the Membranes: A Systematic Review

Sara Kenyon, RM^*, Michel Boulvain, MD, PhD and Jim Neilson, MD

From the *Department of Obstetrics and Gynaecology, University of Leicester, United Kingdom; Department of Obstetrics and Gynecology, University of Geneva, Switzerland; and Department of Obstetrics and Gynaecology, University of Liverpool, United Kingdom.

Address reprint requests to: Michel Boulvain, Maternité-HUG, Geneva 14, CH-1211, Switzerland; e-mail: michel.boulvain{at}hcuge.ch.

OBJECTIVE: We sought to evaluate the administration of antibiotics to pregnant women with preterm rupture of membranes (PROM).

DATA SOURCES: We collected data by using the Cochrane Controlled Trials Register and MEDLINE.

METHODS OF STUDY SELECTION: We included randomized controlled comparisons of antibiotic versus placebo (14 trials, 6,559 women).

TABULATION, INTEGRATION, AND RESULTS: Antibiotics were associated with a statistically significant reduction in maternal infection and chorioamnionitis. There also was a reduction in the number of infants born within 48 hours and 7 days and with the following morbidities: neonatal infection (relative risk [RR] 0.67, 95% confidence interval [CI] 0.52–0.85), positive blood culture (RR 0.75, 95% CI 0.60–0.93), use of surfactant (RR 0.83 95% CI 0.72–0.96), oxygen therapy (RR 0.88, 95% CI 0.81–0.96), and abnormal cerebral ultrasound scan before discharge from hospital (RR 0.82, 95% CI 0.68–0.99). Perinatal mortality was not significantly reduced (RR 0.91, 95% CI 0.75–1.11). A benefit was present both in trials where penicillins and erythromycin were used. Amoxicillin/clavulanate was associated with a highly significant increase in the risk of necrotizing enterocolitis (RR 4.60, 95% CI 1.98–10.72).

CONCLUSION: The administration of antibiotics after PROM is associated with a delay in delivery and a reduction in maternal and neonatal morbidity. These data support the routine use of antibiotics for women with PROM. Penicillins and erythromycin were associated with similar benefits, but erythromycin was used in larger trials and, thus, the results are more robust. Amoxicillin/clavulanate should be avoided in women at risk of preterm delivery because of the increased risk of neonatal necrotizing enterocolitis. Antibiotic administration after PROM is beneficial for both women and neonates.

This article has been cited by other articles:

				G. G. Briggs and S. R. Wan Drug therapy during labor and delivery, part 1. Am. J. Health Syst. Pharm., June 1, 2006; 63(11): 1038 - 1047. [Abstract] [Full Text] [PDF]

				Other articles noted Evid. Based Med., June 1, 2005; 10(3): 95 - 96. [Full Text] [PDF]