Antibiotics for preterm rupture of membranes (Cochrane Review)

A substantive amendment to this systematic review was last made on 24 January 2003. Cochrane reviews are regularly checked and updated if necessary.

Background: Premature birth carries substantial neonatal morbidity and mortality. One cause, associated with preterm rupture of membranes (pROM), is often subclinical infection. Maternal antibiotic therapy might lessen infectious morbidity and delay labour, but could suppress labour without treating underlying infection.

Objectives: To evaluate the immediate and long term effects of administering antibiotics to women with pROM before 37 weeks, on maternal infectious morbidity, fetal and neonatal morbidity and mortality, and longer term childhood development.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register (January 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2002).

Selection criteria: Randomised controlled trials comparing antibiotic administration with placebo that reported clinically relevant outcomes were included. In addition, trials, in which no placebo was used, were included for the outcome of perinatal death alone.

Data collection and analysis: Data were extracted from each report without blinding of either the results or the treatments that women received. Unpublished data were sought from a number of authors.

Main results: Nineteen trials involving over 6000 women and their babies were included. The use of antibiotics following pROM is associated with a statistically significant reduction in chorioamnionitis (relative risk (RR) 0.57, 95% confidence interval (CI) 0.37 to 0.86). There was a reduction in the numbers of babies born within 48 hours (RR 0.71, 95% CI 0.58 to 0.87) and seven days of randomisation (RR 0.80, 95% CI 0.71 to 0.90). The following markers of neonatal morbidity were reduced: neonatal infection (RR 0.68, 95% CI 0.53 to 0.87), use of surfactant (RR 0.83, 95% CI 0.72 to 0.96), oxygen therapy (RR 0.88, 95% CI 0.81 to 0.96), and abnormal cerebral ultrasound scan prior to discharge from hospital (RR 0.82, 95% CI 0.68 to 0.98). Co-amoxiclav was associated with an increased risk of neonatal necrotising enterocolitis (RR 4.60, 95% CI 1.98 to 10.72).

Reviewers' conclusions: Antibiotic administration following pROM is associated with a delay in delivery and a reduction in major markers of neonatal morbidity. These data support the routine use of antibiotics in pPROM.The choice as to which antibiotic would be preferred is less clear as, by necessity, fewer data are available. Co-amoxiclav should be avoided in women at risk of preterm delivery because of the increased risk of neonatal necrotising enterocolitis. From the available evidence, erythromycin would seem a better choice.

Citation: Kenyon S, Boulvain M, Neilson J. Antibiotics for preterm rupture of membranes (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

---

This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

The Cochrane Library is designed and produced by Update Software Ltd.

Update Software Ltd, Summertown Pavilion, Middle Way, Oxford OX2 7LG, UK
(Tel:+44 1865 513902; Fax:+44 1865 516918)

File Reference: AB001058.htm