title: The early use of appropriate prophylactic antibiotics in susceptible women for the prevention of preterm birth of infectious etiology.
abstract: BACKGROUND
  Preterm birth is the major cause of perinatal mortality and morbidity in high-income countries. The etiology of preterm birth is multifactorial but there is overwhelming evidence to implicate infection as a major cause. Abnormal genital tract flora in early pregnancy is predictive of preterm birth so it is logical to consider the use of antibiotics for the prevention of preterm birth.
  
  
  METHODS
  Infection and antibiotics in the etiology, prediction and prevention of preterm birth.
  
  
  CONCLUSIONS
  Antibiotics for the prevention of preterm birth have addressed different risk groups, diagnostic methods, degrees of abnormal flora, antibiotic dose regimens, routes of administration, host susceptibilities, host response, gestational age at time of treatment, outcome parameters and definitions of success and outcomes. To address this confusion, a number of systematic reviews/meta-analyses have been conducted but none has simultaneously addressed the optimal choice of agent, patient and timing of intervention. We conclude that inappropriate antibiotics used in inappropriate women at inappropriately late gestations do not reduce preterm birth. Conversely, a focused systematic review/meta-analysis, which targeted the use of clindamycin before 22 weeks gestation, in women with objective evidence of abnormal genital tract flora, demonstrated that clindamycin produced a significant decrease in late miscarriage and preterm birth.
authors.affiliation: University of Southern Denmark, Clinical Institute, Odense University Hospital, Department of Gynecology and Obstetrics , Odense , Denmark.
authors.forename: Jan Stener
authors.initials: JS
authors.lastname: Joergensen
authors.forename: Louise Katrine
authors.initials: LK
authors.lastname: Kjær Weile
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Lamont
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002981:Clindamycin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D047928:Premature Birth / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D002981:Clindamycin
keywords: abnormal genital tract flora; antibiotics; bacterial vaginosis; clindamycin; metronidazole; preterm birth; prevention; spontaneous preterm labor