[Management of threatening preterm labor with intact membranes: indications for antibiotics].
OBJECTIVE
To analyse the benefits and disadvantages of systematic antibiotic therapy in patient presenting a preterm labor with intact membranes.


METHODS
We reviewed French and English reports on Medline using to the following key words: "antibiotic therapy and preterm labor, preterm labor, streptococcus B, vaginose, mycoplasma, antenatal infection".


RESULTS
The systematic prescription of antibiotics is not recommended for patients presenting preterm labor who have intact membranes and no symptoms of infection. The benefit of antibiotics is small and shows a tendency to prolong the pregnancy and the reduction of maternal infection. No benefit has been shown for neonatal results. When early-onset neonatal sepsis develops in a case in which antepartum chemoprophylaxis was used, the isolated bacteria will present an increasing risk of bacterial drug resistance. Local treatment (cream or pessary) do not belong in the treatment of threatening preterm labor and are not recommended for the prevention of prematurity or materno fetal infection. Risk groups of patients who present a positive vaginal colonization are subject to discussion. Studies do not allow us to ascertain that antibiotics have a beneficial effect on prematurity in these groups. Antibiotics are recommended for the treatment of asymptomatic bacteriuria. This treatment reduces prematurity and maternal infections. Despite poor consensus criteria, if threatening preterm labor is associated with a bacteriuria, experts usually recommend treatment.
Winer
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Service d'Obstétrique et Médecine Foetale, CHU de Nantes, Hôpital Mère-Enfant, 44093 Nantes, France. norbert.winer@chu-nantes.fr
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005321:Extraembryonic Membranes; D005260:Female; D005602:France; D006801:Humans; D009175:Mycoplasma Infections / Q000188:drug therapy; D007752:Obstetric Labor, Premature / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D013290:Streptococcal Infections / Q000188:drug therapy; D013292:Streptococcus agalactiae; D016896:Treatment Outcome; D016585:Vaginosis, Bacterial / Q000188:drug therapy*
D000900:Anti-Bacterial Agents