Antibiotics: treatment of preterm labor

Our intention is to review recent data and provide recommendations for the use of antibiotics in cases of preterm labor or preterm premature rupture of the membranes (pPROM). Various studies assessing antibiotics as treatment for preterm labor demonstrate neonatal or maternal benefits only in certain circumstances. Antibiotic treatment should be given to patients with bacterial vaginosis and Trichomonas vaginalis. Currently, antibiotics should not be applied routinely to prolong pregnancy in women with preterm labor and intact membranes. However, antibiotic therapy should be given to patients with pPROM to prolong pregnancies at 24 to 32 weeks' gestation. Our management of pPROM up to 32 weeks' gestation includes use of corticosteroids, antibiotic (extended spectrum penicillins) and tocolytic treatment for preterm labor and pregnancy prolongation. We consider expectant management previous to evidence of intrauterine infection. In women with pPROM at 32 to 34 weeks we found it beneficial to deliver 24 hours after administration of corticosteroids or, in cases of intrauterine infection, immediately. Finally, we report on our research work regarding fetal brain development in preterm birth. Further studies will be necessary to clarify the role of the interleukin-6/interleukin-6 receptor pathway in the development of intracerebral hemorrhage frequently occuring in premature infants.