Antibiotics for preterm rupture of membranes

Kenyon S, Boulvain M, Neilson JP

Published Online:

August 8, 2010

Certain antibiotics given to women with early broken waters will improve babies' health. Babies born too soon are more likely to suffer ill health in the early days and sometimes throughout life. Early labour and birth (before 37 weeks) may be due to undetected infection as well as the waters breaking early. The review of 22 trials, involving 6800 women and their babies, found that, in the short term, certain antibiotics given to women, when their waters break early, increase the time babies stay in the womb. They reduced infection, but did not save more babies. One antibiotic (co-amoxiclav) increased the number of babies with a rare condition of inflammation of the bowel (necrotising enterocolitis). The longer term (at seven years of age) antibiotics seem to have little effect on the health of children. It is not clear whether antibiotics should be prescribed for women whose waters break early, and if they are, which would be the antibiotic of choice.

Abstract (click to read)

Background:

Premature birth carries substantial neonatal morbidity and mortality. Subclinical infection is associated with preterm rupture of membranes (PROM). Prophylactic 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, neonatal morbidity and mortality, and longer-term childhood development.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (29 April 2010).

Selection criteria:

Randomised controlled trials comparing antibiotic administration with placebo that reported clinically relevant outcomes were included as were trials of different antibiotics. Trials in which no placebo was used were included for the outcome of perinatal death alone.

Data collection and analysis:

We extracted data from each report without blinding of either the results or the treatments that women received. We sought unpublished data from a number of authors.

Main results:

We included 22 trials, involving 6800 women and babies.

The use of antibiotics following PROM is associated with statistically significant reductions in chorioamnionitis (average risk ratio (RR) 0.66, 95% confidence interval (CI) 0.46 to 0.96, and a reduction in the numbers of babies born within 48 hours (average RR 0.71, 95% CI 0.58 to 0.87) and seven days of randomisation (average RR 0.79, 95% CI 0.71 to 0.89). The following markers of neonatal morbidity were reduced: neonatal infection (RR 0.67, 95% CI 0.52 to 0.85), 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 0.81, 95% CI 0.68 to 0.98). Co-amoxiclav was associated with an increased risk of neonatal necrotising enterocolitis (RR 4.72, 95% CI 1.57 to 14.23).

One study evaluated the children's health at seven years of age (ORACLE Children Study) and found antibiotics seemed to have little effect on the health of children.

Authors' conclusions:

The decision to prescribe antibiotics for women with PROM is not clearcut. Benefits in some short-term outcomes (prolongation of pregnancy, infection, less abnormal cerebral ultrasound before discharge from hospital) should be balanced against a lack of evidence of benefit for others, including perinatal mortality, and longer term outcomes. If antibiotics are prescribed it is unclear which would be the antibiotic of choice.

Co-amoxiclav should be avoided in women at risk of preterm delivery due to increased risk of neonatal necrotising enterocolitis.

This record should be cited as:

Kenyon S, Boulvain M, Neilson JP. Antibiotics for preterm rupture of membranes. Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: CD001058. DOI: 10.1002/14651858.CD001058.pub2

Assessed as up to date:

July 7, 2010

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Pregnancy & childbirth > Pre-labour rupture of membranes > Preterm

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Antibiotics for preterm rupture of membranes

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