Up to 35 percent of all pregnancies...

Up to 35 percent of all pregnancies and 30 to 40 percent of preterm deliveries are complicated through preterm rupture of the fetal membranes (PROM) The etiology of PROM is multifactorial. Bacterial infection may weaken the fetal membranes leading to break and colonization after rupture can cause chorioamnionitis, deciduitis, or fetal infection. Although antibiotic therapy could be count uponed to reduce infectious complications of PROM troubles have been raised that delaying delivery after feud could be associated with neuro-developmental delay in the infant. Kenyon and colleagues demeanored a systematic review of the consequences of antibiotic use in PROM including a comparison of the different agents commonly used to preclude complications.

The authors identified relevant randomized placebo-controlled trials from searching electronic databases of publications, clinical trials, and talk abstracts. Maternal outcomes were death, serious morbidity, adverse reaction to medication, chorioamnionitis, and infection after delivery or before discharge. Neonatal issues included perinatal death, neonatal morbidity, and developmental delay in childhood.

Of the 33 studies identified during the search, 19 trials involving 6951 mothers met criteria for inclusion in the analysis. The use of antibiotics after PROM was associated with a significant reduction in chorioamnionitis (relative risk [RR] = 057) and in the number of infants born within 48 hours (RR = 071) and seven days (RR = 080) of randomization. No adverse physic reactions were noted from antibiotic therapy.

The use of antibiotics after PROM also significantly reduc the number of neonatal infections (RR = 067); the number of infants requiring oxygen therapy (RR = 088); the number of days infants wearied in neonatal intensive care (by approximately five days); and the number of neonates with an abnormal cerebral ultrasound scan before hospital discharge. It also increased the birth weight (average: 5153 g) of the infants. The number of women who exigencyed to be treated with antibiotics to avoid united additional unfavorable outcome in the infant ranged from seven to 69 (see accompanying table). Overall, use of antibiotics was not associated with a statistically significant reduction in perinatal mortality.

Benefit was demonstrated in trials involving penicillins and erythromycin, if it be not that data were insufficient to compare different antibiotic regimens. Because erythromycin was used in larger trials, the evidence supporting its use was more robust. The incidence of necrotizing enterocolitis rose significantly when amoxicillin-clavulanate (Augmentin) was used.

The authors gather that the use of antibiotics after PROM makes maternal and neonatal morbidity. The data support the routine use of erythromycin or other penicillins to improve results for mothers and infants. The authors also advise against the use of amoxicillin-clavulanate because of its increased risk of necrotizing enterocolitis. Further long-term follow-up will ne to be complet to assess the health and evolution of the children involved in this trial.

ANNE D WALLING, MD

Kenyon s et al. Antibiotics for preterm breach of the membranes: a systematic review. Obstet Gynecol November 2004;104:1051-7

COPYRIGHT 2005 American Academy of Family Physicians

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