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DOI: 10.1055/s-0039-1683378
The Effect of Non-penicillin Antibiotic Regimens on Neonatal Outcomes in Preterm Premature Rupture of Membranes
Publication History
12 November 2018
09 January 2019
Publication Date:
07 March 2019 (online)
![](https://www.thieme-connect.de/media/ajpr/201901/lookinside/thumbnails/10-1055-s-0039-1683378_190001-1.jpg)
Abstract
Objective A 7-day course of a penicillin (PCN) and macrolide is standard of care (SAR) in preterm premature rupture of membranes (PPROM). Data regarding alternative antibiotic regimens are limited. We sought to assess the impact of non-PCN regimens on neonatal outcomes.
Study Design Secondary analysis of randomized controlled trial of antenatal magnesium sulfate. Singleton, nonanomalous pregnancies complicated by PPROM at > 24 weeks of gestation receiving the SAR were compared with women receiving a non-β-lactam regimen and a macrolide (NPCR). Primary outcome was a neonatal composite. Secondary outcomes included pregnancy latency, endometritis, and chorioamnionitis.
Results A total of 949 women met inclusion criteria; 821(56%) received the SAR and 128(8.8%) received NPCR. Adjusted models did not demonstrate worse outcomes (AOR [adjusted odds ratio] = 0.50; 95% CI [confidence interval]: 0.22–1.11). Neonates receiving SAR were less likely to have bronchopulmonary dysplasia (BPD; p = 0.03) but more likely to have severe necrotizing enterocolitis (sNEC; p = 0.04). Risk for chorioamnionitis and median latency did not differ between groups but women receiving the SAR were less likely to get endometritis (AOR = 0.35; 95% CI: 0.14–0.91).
Conclusions In this cohort, receiving NPCR in the setting of PPROM did not impact the overall risk of adverse neonatal outcomes or latency, but did increase the risk of endometritis. Alterations in individual neonatal morbidities suggest follow-up studies are needed.
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References
- 1 Waters TP, Mercer B. Preterm PROM: prediction, prevention, principles. Clin Obstet Gynecol 2011; 54 (02) 307-312
- 2 Spinillo A, Capuzzo E, Stronati M, Ometto A, Orcesi S, Fazzi E. Effect of preterm premature rupture of membranes on neurodevelopmental outcome: follow up at two years of age. Br J Obstet Gynaecol 1995; 102 (11) 882-887
- 3 Mercer BM, Miodovnik M, Thurnau GR. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. JAMA 1997; 278 (12) 989-995
- 4 Magwali TL, Chipato T, Majoko F, Rusakaniko S, Mujaji C. Prophylactic augmentin in prelabor preterm rupture of the membranes. Int J Gynaecol Obstet 1999; 65 (03) 261-265
- 5 Christmas JT, Cox SM, Andrews W, Dax J, Leveno KJ, Gilstrap LC. Expectant management of preterm ruptured membranes: effects of antimicrobial therapy. Obstet Gynecol 1992; 80 (05) 759-762
- 6 Amon E, Lewis SV, Sibai BM, Villar MA, Arheart KL. Ampicillin prophylaxis in preterm premature rupture of the membranes: a prospective randomized study. Am J Obstet Gynecol 1988; 159 (03) 539-543
- 7 Ovalle A, Martínez MA, Kakarieka E. , et al. Antibiotic administration in patients with preterm premature rupture of membranes reduces the rate of histological chorioamnionitis: a prospective, randomized, controlled study. J Matern Fetal Neonatal Med 2002; 12 (01) 35-41
- 8 Macy E. Penicillin and beta-lactam allergy: epidemiology and diagnosis. Curr Allergy Asthma Rep 2014; 14 (11) 476
- 9 Salkind AR, Cuddy PG, Foxworth JW. The rational clinical examination. Is this patient allergic to penicillin? An evidence-based analysis of the likelihood of penicillin allergy. JAMA 2001; 285 (19) 2498-2505
- 10 Rouse DJ, Hirtz DG, Thom E. , et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008; 359 (09) 895-905
- 11 Kenyon S, Boulvain M, Neilson JP. Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev 2010; (08) CD001058
- 12 Hopkins MK, Dotters-Katz S, Boggess K, Heine RP, Smid M. Perioperative antibiotic choice in labored versus unlabored Cesareans and risk of postcesarean infectious morbidity. Am J Perinatol 2018; 35 (02) 127-133
- 13 Kenyon SL, Taylor DJ, Tarnow-Mordi W. ; ORACLE Collaborative Group. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. Lancet 2001; 357 (9261): 979-988
- 14 Weintraub AS, Ferrara L, Deluca L. , et al. Antenatal antibiotic exposure in preterm infants with necrotizing enterocolitis. J Perinatol 2012; 32 (09) 705-709
- 15 Silverman MA, Konnikova L, Gerber JS. Impact of antibiotics on necrotizing enterocolitis and antibiotic-associated diarrhea. Gastroenterol Clin North Am 2017; 46 (01) 61-76
- 16 Munyaka PM, Eissa N, Bernstein CN, Khafipour E, Ghia JE. Antepartum antibiotic treatment increases offspring susceptibility to experimental colitis: a role of the gut microbiota. PLoS One 2015; 10 (11) e0142536
- 17 Nogacka A, Salazar N, Suárez M. , et al. Impact of intrapartum antimicrobial prophylaxis upon the intestinal microbiota and the prevalence of antibiotic resistance genes in vaginally delivered full-term neonates. Microbiome 2017; 5 (01) 93
- 18 Hall CM, Milligan DW, Berrington J. Probable adverse reaction to a pharmaceutical excipient. Arch Dis Child Fetal Neonatal Ed 2004; 89 (02) F184
- 19 Gershanik J, Boecler B, Ensley H, McCloskey S, George W. The gasping syndrome and benzyl alcohol poisoning. N Engl J Med 1982; 307 (22) 1384-1388