Comparison of antibiotic regimens in preterm premature rupture of membranes: neonatal morbidity and 2-year follow-up of neurologic outcome.
OBJECTIVE
The objective of this study was to compare neonatal morbidity and neurologic outcome at 2 years between groups treated with antibiotics regimens consisting clarithromycin and erythromycin in preterm premature rupture of the membranes (pPROM) patients delivered before 32 weeks of gestation.


METHODS
This was a retrospective study comparing neonatal morbidity as primary outcome measures and the neurological outcome at 2 years as secondary outcome.


RESULTS
A total of 166 women were included: 80 treated with erythromycin and 86 treated with clarithromycin. The median gestational age at delivery was greater in clarithromycin group (p = 0.005). There was no significant difference in latency (p = 0.77). The incidence of histological chorioamnionitis was significantly lower in clarithromycin group (p = 0.004). By multivariable analysis adjusting confounding variables, the incidence of bronchopulmonary dysplasia and intraventricular hemorrhage (≥Grade 3) was lower in clarithromycin group (BPD; OR 0.34, 95% CI [0.13-0.90]), IVH; OR 0.23, 95% CI [0.06-0.91], respectively). Other morbidities and neurologic outcome at 2 years' corrected age showed no statistically significant difference between two groups.


CONCLUSIONS
We suggest that clarithromycin-based regimen may be worth considering as an alternative choice of erythromycin in pPROM patients.
a Department of Obstetrics and Gynecology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea.
Kylie Hae-Jin
KH
Chang
a Department of Obstetrics and Gynecology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea.
Hyun-Joo
HJ
Kim
b Department of Pediatrics , Sacred Heart Hospital, Hallym University College of Medicine , Anyang , Republic of Korea.
Hee Joon
HJ
Yu
c Department of Pediatrics , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea , and.
Jeehun
J
Lee
d Department of Pathology, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , Republic of Korea.
Jung-Sun
JS
Kim
a Department of Obstetrics and Gynecology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea.
Suk-Joo
SJ
Choi
a Department of Obstetrics and Gynecology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea.
Soo-Young
SY
Oh
a Department of Obstetrics and Gynecology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea.
Cheong-Rae
CR
Roh
a Department of Obstetrics and Gynecology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea.
Jong-Hwa
JH
Kim
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002511:Cephalosporins / Q000008:administration & dosage; D017291:Clarithromycin / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004917:Erythromycin / Q000008:administration & dosage*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy*; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013997:Time Factors
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D004917:Erythromycin; D017291:Clarithromycin
Bronchopulmonary dysplasia; clarithromycin; erythromycin; intraventricular hemorrhage; preterm premature rupture of the membranes