Antibiotics for preterm rupture of membranes.
BACKGROUND
Premature birth carries substantial neonatal morbidity and mortality. One cause, associated with preterm rupture of membranes (pROM), is often subclinical infection. Maternal antibiotic therapy might lessen infectious morbidity and delay labour, but could suppress labour without treating underlying infection.


OBJECTIVE
To evaluate the immediate and long-term effects of administering antibiotics to women with pROM before 37 weeks, on maternal infectious morbidity, fetal and neonatal morbidity and mortality, and longer term childhood development.


METHODS
We searched the Cochrane Pregnancy and Childbirth Group trials register (January 2003) and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2002).


METHODS
Randomised controlled trials comparing antibiotic administration with placebo that reported clinically relevant outcomes, were included. In addition, trials, in which no placebo was used, were included for the outcome of perinatal death alone.


METHODS
Data were extracted from each report without blinding of either the results or the treatments that women received. Unpublished data were sought from a number of authors.


RESULTS
Nineteen trials involving over 6000 women and their babies were included. The use of antibiotics following pROM is associated with a statistically significant reduction in chorioamnionitis (relative risk (RR) 0.57, 95% confidence interval (CI) 0.37 to 0.86). There was a reduction in the numbers of babies born within 48 hours (RR 0.71, 95% CI 0.58 to 0.87) and seven days of randomisation (RR 0.80, 95% CI 0.71 to 0.90). The following markers of neonatal morbidity were reduced: neonatal infection (RR 0.68, 95% CI 0.53 to 0.87), use of surfactant (RR 0.83, 95% CI 0.72 to 0.96), oxygen therapy (RR 0.88, 95% CI 0.81 to 0.96), and abnormal cerebral ultrasound scan prior to discharge from hospital (RR 0.82, 95% CI 0.68 to 0.98). Co-amoxiclav was associated with an increased risk of neonatal necrotising enterocolitis (RR 4.60, 95% CI 1.98 to 10.72).


CONCLUSIONS
Antibiotic administration following pROM is associated with a delay in delivery and a reduction in major markers of neonatal morbidity. These data support the routine use of antibiotics in pPROM. The choice as to which antibiotic would be preferred is less clear as, by necessity, fewer data are available. Co-amoxiclav should be avoided in women at risk of preterm delivery because of the increased risk of neonatal necrotising enterocolitis. From the available evidence, erythromycin would seem a better choice.
Kenyon
S
S
ORACLE Clinical Co-ordinating Centre, Leicester Royal Infirmary, Department of Obstetrics, Clinical Sciences Building, PO Box 65, Leicester, UK, LE2 7ZR. oracle@le.ac.uk
Boulvain
M
M
Neilson
J
J
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D036861:Delivery, Obstetric; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control; D018942:Macrolides; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic
D000900:Anti-Bacterial Agents; D018942:Macrolides