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Antibiotics for ureaplasma in the vagina in pregnancy
Camille H Raynes Greenow1, Christine L Roberts, Jane C Bell
1School of Public Health, University of Sydney, Rm 125, Edward Ford Building A27, Sydney, New South Wales, Australia, 2006.
Insights
Antibiotic treatment for heavy vaginal ureaplasma colonization in pregnant women did not significantly reduce preterm birth rates in one trial. More research is needed to determine if antibiotics prevent adverse pregnancy outcomes.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Infectious Diseases
Background:
- Preterm birth is a major cause of perinatal morbidity and mortality.
- Heavy vaginal Ureaplasma colonization is implicated in preterm birth and preterm prelabour rupture of membranes.
- Antibiotic use for preterm prelabour rupture of membranes shows short-term benefits, but early pregnancy use for colonization is unclear.
Purpose of the Study:
- To evaluate if antibiotic treatment for pregnant women with heavy vaginal Ureaplasma colonization reduces preterm birth and other adverse pregnancy outcomes.
Main Methods:
- Searched the Cochrane Pregnancy and Childbirth Group's Trials Register.
- Included one randomized controlled trial comparing antibiotic regimens (erythromycin, clindamycin) with placebo.
- Assessed eligibility, trial quality, and extracted data independently.
Main Results:
- One trial of 1071 women (644 treated between 22-32 weeks gestation) found no statistically significant difference in low birthweight (<2500g) between erythromycin and placebo.
- Preterm birth data was not reported in the trial.
- No significant differences in treatment-stopping side effects were observed.
Conclusions:
- Insufficient evidence exists to support antibiotic treatment for vaginal Ureaplasma colonization in pregnant women to prevent preterm birth.
- Further research is necessary to clarify the role and benefit of antibiotics in early pregnancy for Ureaplasma colonization.
- Ureaplasmas are suspected contributors to preterm birth and membrane rupture, warranting investigation into early antibiotic intervention.
Background:
Preterm birth is a significant perinatal problem contributing to perinatal morbidity and mortality. Heavy vaginal ureaplasma colonisation is suspected of playing a role in preterm birth and preterm rupture of the membranes. Antibiotics are used to treat infections and have been used to treat pregnant women with preterm prelabour rupture of the membranes, resulting in some short-term improvements. However, the benefit of using antibiotics in early pregnancy to treat heavy vaginal colonisation is unclear.
Objectives:
To assess whether antibiotic treatment of pregnant women with heavy vaginal ureaplasma colonisation reduces the incidence of preterm birth and other adverse pregnancy outcomes.
Search Strategy:
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2011).
Selection Criteria:
Randomised controlled trials comparing any antibiotic regimen with placebo or no treatment in pregnant women with ureaplasma detected in the vagina.
Data Collection And Analysis:
Three review authors independently assessed eligibility and trial quality and extracted data.
Main Results:
We included one trial, involving 1071 women. Of these, 644 women between 22 weeks and 32 weeks' gestation were randomly assigned to one of three groups of antibiotic treatment (n = 174 erythromycin estolate, n = 224 erythromycin stearate, and n = 246 clindamycin hydrochloride) or a placebo (n = 427). Preterm birth data was not reported in this trial. Incidence of low birthweight less than 2500 grams was only evaluated for erythromycin (combined, n = 398) compared to placebo (n = 427) and there was no statistically significant difference between the two groups (risk ratio (RR) 0.70, 95% confidence interval (CI) 0.46 to 1.07). There were no statistically significant differences in side effects sufficient to stop treatment between either group (RR 1.25, 95% CI 0.85 to 1.85).
Authors' Conclusions:
There is insufficient evidence to assess whether pregnant women who have vaginal colonisation with ureaplasma should be treated with antibiotics to prevent preterm birth.Preterm birth is a significant perinatal problem. Upper genital tract infections, including ureaplasmas, are suspected of playing a role in preterm birth and preterm rupture of the membranes. Antibiotics are used to treat women with preterm prelabour rupture of the membranes; this may result in prolongation of pregnancy and lowers the risks of maternal and neonatal infection. However, antibiotics may be beneficial earlier in pregnancy to eradicate potentially causative agents.
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