title: The HPTN 024 Study: the efficacy of antibiotics to prevent chorioamnionitis and preterm birth.
abstract: OBJECTIVE
  The use of antibiotics to prevent preterm birth has achieved mixed results. Our goal in this study was to determine if antibiotics given prenatally and during labor reduce the incidence of preterm birth and histologic chorioamnionitis.
  
  
  METHODS
  A double-blind randomized placebo-controlled trial of antibiotics to reduce preterm birth was conducted in 4 African sites. Both HIV-infected and uninfected pregnant women were given 2 courses of antibiotics, prenatally at 24 weeks (metronidazole 250 mg and erythromycin 250 mg tid orally for 7 days), and during labor (metronidazole 250 mg and ampicillin 500 mg q 4 hours) or identically appearing placebos. Two thousand ninety-eight HIV-infected and 335 HIV-uninfected women had evaluable end points, including gestational age determined by both obstetric and pediatric criteria and birth weight (BWT). Pre- and post-treatment rates of various sexually transmitted infections (STI) were determined and placentas were evaluated for histologic chorioamnionitis.
  
  
  RESULTS
  Comparing antibiotic versus placebo treated HIV-infected and uninfected women, there were few differences in mean gestational age at delivery, the percent of preterm births, the time between randomization and delivery, or BWT. Four weeks after the 24-week antibiotic/placebo course, bacterial vaginosis, and trichomoniasis were reduced by 49% to 61% in the antibiotic groups compared with the placebo groups. However, in both the HIV-infected and uninfected groups, the placentas showed no difference in the rate of histologic chorioamnionitis. There were significant differences between HIV-infected and uninfected women, with the former having less education, a history of more stillbirths, more STIs, and in this pregnancy, a lower BWT (2949 vs 3100 g, P < .0001).
  
  
  CONCLUSIONS
  Despite reducing the rate of vaginal infections, the antibiotic regimen used in this study did not reduce the rate of preterm birth, increase the time to delivery, or increase BWT. Failure of this regimen to reduce the rate of histologic chorioamnionitis may explain the reason the antibiotics failed to reduce preterm birth.
authors.affiliation: Department of Obstetrics and Gynecology, University of Alabama, Birmingham, AL, USA. rlg@uab.edu
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: Anthony
authors.initials: A
authors.lastname: Mwatha
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Read
authors.forename: Samuel
authors.initials: S
authors.lastname: Adeniyi-Jones
authors.forename: Moses
authors.initials: M
authors.lastname: Sinkala
authors.forename: Gernard
authors.initials: G
authors.lastname: Msmanga
authors.forename: Francis
authors.initials: F
authors.lastname: Martinson
authors.forename: Irving
authors.initials: I
authors.lastname: Hoffman
authors.forename: Wafaie
authors.initials: W
authors.lastname: Fawzi
authors.forename: Megan
authors.initials: M
authors.lastname: Valentine
authors.forename: Lynda
authors.initials: L
authors.lastname: Emel
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Brown
authors.forename: Victor
authors.initials: V
authors.lastname: Mudenda
authors.forename: Taha E
authors.initials: TE
authors.lastname: Taha
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002821:Chorioamnionitis / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents