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Erythromycin therapy in preterm premature rupture of the membranes: a prospective, randomized trial of 220 patients
B M Mercer1, M L Moretti, R R Prevost
1Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38103.
Insights
Oral erythromycin therapy can prolong latency in preterm premature rupture of membranes (PPROM) and reduce infection risk in specific cases. However, it does not prevent clinical infection or decrease neonatal morbidity.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Infectious Diseases
Background:
- Preterm premature rupture of membranes (PPROM) poses risks of infection and adverse outcomes.
- Prophylactic antibiotic use in PPROM requires further investigation for efficacy.
- Erythromycin is a potential agent for managing PPROM-related infections.
Purpose of the Study:
- To assess the effectiveness of oral erythromycin in extending latency period after PPROM.
- To determine if erythromycin reduces infectious complications in mothers and newborns.
- To evaluate erythromycin's impact on chorioamnionitis and oligohydramnios in PPROM.
Main Methods:
- Randomized, prospective, double-blind, placebo-controlled trial.
- 220 women with PPROM between 20-35 weeks gestation were enrolled.
- Participants received oral erythromycin or placebo every 8 hours until delivery.
Main Results:
- Erythromycin significantly prolonged latency (p = 0.02).
- Latency was particularly extended in women with chorioamnionitis (p = 0.003) and oligohydramnios (p = 0.01).
- No significant reduction in maternal or neonatal infectious morbidity was observed.
Conclusions:
- Oral erythromycin delays, but does not prevent, clinical infection onset in PPROM.
- This antibiotic regimen does not reduce neonatal morbidity or mortality.
- Erythromycin may be beneficial for specific subgroups of PPROM patients, warranting further research.
Objectives:
The use of prophylactic antibiotics in the management of preterm premature rupture of the membranes has not been adequately studied. The purpose of this study was to evaluate the efficacy of oral erythromycin therapy in the prolongation of latency and reduction of infectious morbidity after preterm premature rupture of membranes.
Study Design:
In this randomized, prospective, double-blind, placebo-controlled study, 220 women at 20 to 35 weeks' gestation were evaluated. Subjects received oral erythromycin 333 mg (n = 106) or indistinguishable placebo (n = 114) every 8 hours from randomization to delivery.
Results:
Prolongation of latency was identified with erythromycin therapy (p = 0.02), particularly for those destined to have chorioamnionitis (p = 0.003) and those with oligohydramnios (p = 0.01). No decrease in the incidence of maternal or neonatal infectious morbidity was seen.
Conclusions:
Oral erythromycin delays, but does not prevent, the onset of clinical infection when administered to women with preterm premature rupture of membranes. This regimen does not decrease neonatal morbidity and mortality.
