What is the role of antibiotics in the management of premature preterm rupture of membranes (PPROM)?

Updated: Oct 05, 2018
  • Author: Allahyar Jazayeri, MD, PhD, FACOG, DACOG, FSMFM; Chief Editor: Carl V Smith, MD  more...
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The initial step in management of PPROM is informed consent. The patient needs to be given risks and benefits information and must participate in decision making. Once the decision to manage a patient expectantly has been made, the institution of broad-spectrum antibiotics should be considered. Multiple trials have examined the advantages and disadvantages of using antibiotics and the choice of antibiotics. In most studies, use of antibiotics has been associated with prolongation of pregnancy and reduction in infant and maternal morbidity. However, a few studies have reported increased neonatal morbidity with certain types of antibiotics, as discussed below.

Two of the largest studies that have looked at the efficacy of antibiotic use in PPROM are the National Institute of Child Health and Human Development - Maternal Fetal Medicine Units (NICHD-MFMU) study of PROM and the ORACLE trial. In the NICHD study, intravenous antibiotics were used for 48 hours—ampicillin 2 g q6h and erythromycin 250 mg q6h. The patients were then placed on oral amoxicillin 250 mg q8h and enteric-coated, erythromycin-base 333 mg q8h to complete a 7-day course of antibiotic therapy. In this study, the control group, compared with the antibiotic group, had a significantly shorter duration of latency. The antibiotic group was twice as likely to remain undelivered after 7 days. The increased latency continued for up to 3 weeks after discontinuation of antibiotics. Composite and individual morbidities for the neonate were lower in the antibiotic group. The incidence of chorioamnionitis and neonatal sepsis, including group B streptococci sepsis, was decreased. [18]

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