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Macrolide antibiotics roxithromycin vs. azithromycin for preterm premature rupture of membranes: a retrospective

Hanoch Schreiber1,2, Pnina Shitrit3,4, Gili Man-El5,4

  • 1Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St, 44281, Kfar Saba, Israel. hanochsc@gmail.com.

Archives of Gynecology and Obstetrics
|June 23, 2019
PubMed
Abstract

Insights

Azithromycin significantly prolonged latency in preterm premature rupture of membranes compared to roxithromycin. This single-dose macrolide offers a convenient and effective first-line treatment option for expectant mothers.

Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Infectious Diseases

Background:

  • Preterm premature rupture of membranes (PPROM) necessitates prophylactic antibiotics to reduce infection risks and prolong latency.
  • Macrolides are commonly used, with azithromycin offering a convenient single-dose regimen compared to the traditional weekly roxithromycin regimen.

Purpose of the Study:

  • To compare the efficacy of azithromycin versus roxithromycin in prolonging latency and improving outcomes in pregnancies with PPROM.
  • To evaluate secondary outcomes including chorioamnionitis, delivery mode, birth weight, and Apgar scores.

Main Methods:

  • A retrospective comparison of two local protocols: roxithromycin/ampicillin (2005-2016) and azithromycin/ampicillin (2016-2018).
  • Inclusion criteria: singleton pregnancy, PPROM between 24-34 weeks gestation.
  • Primary outcome: latency period duration; Secondary outcomes: infection rates, delivery characteristics, and neonatal assessments.

Main Results:

  • A total of 207 women were analyzed (173 roxithromycin, 34 azithromycin).
  • The azithromycin group demonstrated a significantly longer latency period (14.09 days) compared to the roxithromycin group (7.87 days) (P=0.003).
  • No significant differences were observed in chorioamnionitis rates, delivery mode, birth weight, or Apgar scores between the groups.

Conclusions:

  • Azithromycin, as a single-dose regimen, is superior to weekly roxithromycin in prolonging latency for PPROM at 24-34 weeks gestation.
  • The convenience and efficacy of azithromycin support its use as a first-line treatment for PPROM.
  • Further research may explore optimal dosing and long-term neonatal outcomes.
Keywords:
AzithromycinLatency periodPreterm premature rupture of membranesProphylactic antibioticsRoxithromycin

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