A retrospective comparison of antibiotic regimens for preterm premature rupture of membranes

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Rebecca C Pierson1, Sashana S Gordon, David M Haas

  • 1Indiana University School of Medicine and Department of Medicine, Division of Clinical Pharmacology, and Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana.

Obstetrics and Gynecology
|August 28, 2014
PubMed
Abstract

Insights

Substituting azithromycin for erythromycin in antibiotic regimens for preterm premature rupture of membranes (PPROM) did not alter latency periods or other maternal and fetal outcomes in this study.

Area of Science:

  • Obstetrics and Gynecology
  • Neonatal Medicine
  • Infectious Diseases

Background:

  • Preterm premature rupture of membranes (PPROM) is a significant obstetric complication.
  • Antibiotic therapy is standard for PPROM to prolong latency and improve neonatal outcomes.
  • The role of azithromycin versus erythromycin in PPROM management requires evaluation.

Purpose of the Study:

  • To compare the latency period in women with PPROM treated with ampicillin and azithromycin versus ampicillin and erythromycin.
  • To assess the impact of substituting azithromycin for erythromycin on secondary maternal and neonatal outcomes.

Main Methods:

  • Retrospective cohort study of 168 women with PPROM (24-34 weeks gestation).
  • Comparison of two antibiotic regimens: ampicillin/erythromycin vs. ampicillin/azithromycin.
  • Primary outcome: latency period (time from first antibiotic dose to delivery).
  • Secondary outcomes: chorioamnionitis, cesarean delivery, Apgar scores, birth weight, neonatal death, neonatal sepsis, and respiratory distress syndrome.

Main Results:

  • No significant difference in latency period between the ampicillin/erythromycin (9.6 days) and ampicillin/azithromycin (9.4 days) groups (P=.40).
  • Secondary maternal and neonatal outcomes were similar between the two treatment groups.
  • The study was powered to detect a 5-day difference in latency.

Conclusions:

  • Substitution of azithromycin for erythromycin in ampicillin-based regimens for PPROM does not affect latency.
  • The choice between azithromycin and erythromycin in this context does not appear to influence other key maternal or fetal outcomes.
  • Current antibiotic regimens for PPROM can be maintained with either azithromycin or erythromycin without compromising outcomes.

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