Use of antibiotics for the treatment of preterm parturition and prevention of neonatal morbidity: a metaanalysis.
OBJECTIVE
We conducted a metaanalysis to determine whether antibiotics prolong pregnancy and reduce neonatal morbidity in preterm premature rupture of membranes (PPROM) and preterm labor (PTL) at 34 weeks or less.


METHODS
Randomized trials comparing antibiotic therapy with placebo in PPROM or PTL at a gestation of 34 weeks or less were retrieved. The primary outcome was time to delivery (latency). Infant outcomes included mortality, infection, neurological abnormality, respiratory disease, and neonatal stay.


RESULTS
Antibiotics were associated with prolongation of pregnancy in PPROM (P < .01) but not PTL. Clinically diagnosed neonatal infections were reduced in both groups; there was a trend toward reduced culture-positive sepsis in PPROM. Intraventricular hemorrhage (all grades) was reduced in PPROM. Other neonatal outcomes were unaffected by antenatal antibiotics.


CONCLUSIONS
Antibiotics prolong pregnancy and reduce neonatal morbidity in women with PPROM at a gestation of 34 weeks or less. In PTL at a gestation of 34 weeks or less, there is little evidence of benefit from administration of antibiotics.
Hutzal
Carolyn E
CE
Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Boyle
Elaine M
EM
Kenyon
Sara L
SL
Nash
Jennifer V
JV
Winsor
Stephanie
S
Taylor
David J
DJ
Kirpalani
Haresh
H
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy* / Q000517:prevention & control; D005500:Follow-Up Studies; D006801:Humans; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D007752:Obstetric Labor, Premature / Q000188:drug therapy* / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D011336:Probability; D016032:Randomized Controlled Trials as Topic; D012016:Reference Values; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents