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Objective To assess the impact on the duration of latency to delivery when a single oral dose of azithromycin is substituted for erythromycin in the standard antibiotic regimen used in pregnancies complicated by preterm premature rupture of membranes (PPROM). Study Design A retrospective cohort study of singleton pregnancies complicated by PPROM between 23 and 33 6/7 weeks of gestation from January 2012 to June 2016. Patients prior to June 2014 received a standard antibiotic regimen of 7 days of erythromycin and ampicillin/amoxicillin. After this period, patients received a single oral dose of azithromycin 1 g substituted for erythromycin in this regimen. Primary outcome was latency from PPROM to delivery. Results One hundred sixty-two women met the inclusion criteria, 84 in the erythromycin group and 78 in the azithromycin group. There was no difference in the median latency from PPROM to delivery between the groups (erythromycin: 6.37 days, interquartile range [IQR]: 3.59-10.93 vs. azithromycin: 5.86 days, IQR: 3.12-12.05, p = 0.75). There was a higher rate of cesarean delivery (48.8 vs. 29.5%, p = 0.01) and positive neonatal blood cultures (13.6 vs. 4.1%, p = 0.05) in the erythromycin group. Conclusion There is no difference in latency to delivery when a single oral dose of azithromycin 1 g is substituted for erythromycin in the standard antibiotic regimen used in singleton pregnancies complicated by PPROM. [ABSTRACT FROM AUTHOR]

Objective To assess the impact on the duration of latency to delivery when a single oral dose of azithromycin is substituted for erythromycin in the standard antibiotic regimen used in pregnancies complicated by preterm premature rupture of membranes (PPROM). Study Design A retrospective cohort study of singleton pregnancies complicated by PPROM between 23 and 33 6/7 weeks of gestation from January 2012 to June 2016. Patients prior to June 2014 received a standard antibiotic regimen of 7 days of erythromycin and ampicillin/amoxicillin. After this period, patients received a single oral dose of azithromycin 1 g substituted for erythromycin in this regimen. Primary outcome was latency from PPROM to delivery. Results One hundred sixty-two women met the inclusion criteria, 84 in the erythromycin group and 78 in the azithromycin group. There was no difference in the median latency from PPROM to delivery between the groups (erythromycin: 6.37 days, interquartile range [IQRJ: 3.59-10.93 vs. azithromycin: 5.86 days, IQR: 3.12-12.05, p = 0.75). There was a higher rate of cesarean delivery (48.8 vs. 29.5%, p = 0.01) and positive neonatal blood cultures (13.6 vs. 4.1%, p = 0.05) in the erythromycin group. Conclusion There is no difference in latency to delivery when a single oral dose of azithromycin 1 g is substituted for erythromycin in the standard antibiotic regimen used in singleton pregnancies complicated by PPROM. [ABSTRACT FROM AUTHOR]

Background: Given the global nursing shortage and investments to scale-up the workforce, this study evaluated trends in annual student nurse enrolment, pre-service attrition between enrolment and registration, and factors that influence nurse production in Kenya.Methods: This study used a mixed methods approach with data from the Regulatory Human Resources Information System (tracks initial student enrolment through registration) and the Kenya Health Workforce Information System (tracks deployment and demographic information on licensed nurses) for the quantitative analyses and qualitative data from key informant interviews with nurse training institution educators and/or administrators. Trends in annual student nurse enrolment from 1999 to 2010 were analyzed using regulatory and demographic data. To assess pre-service attrition between training enrolment and registration with the nursing council, data for a cohort that enrolled in training from 1999 to 2004 and completed training by 2010 was analyzed. Multivariate logistic regression was used to test for factors that significantly affected attrition. To assess the capacity of nurse training institutions for scale-up, qualitative data was obtained through key informant interviews.Results: From 1999 to 2010, 23,350 students enrolled in nurse training in Kenya. While annual new student enrolment doubled between 1999 (1,493) and 2010 (3,030), training institutions reported challenges in their capacity to accommodate the increased numbers. Key factors identified by the nursing faculty included congestion at clinical placement sites, limited clinical mentorship by qualified nurses, challenges with faculty recruitment and retention, and inadequate student housing, transportation and classroom space. Pre-service attrition among the cohort that enrolled between 1999 and 2004 and completed training by 2010 was found to be low (6%).Conclusion: To scale-up the nursing workforce in Kenya, concurrent investments in expanding the number of student nurse clinical placement sites, utilizing alternate forms of skills training, hiring more faculty and clinical instructors, and expanding the dormitory and classroom space to accommodate new students are needed to ensure that increases in student enrolment are not at the cost of quality nursing education. Student attrition does not appear to be a concern in Kenya compared to other African countries (10 to 40%). [ABSTRACT FROM AUTHOR]