Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes: a randomized controlled trial

Giving antibiotics to pregnant women who experience preterm premature rupture of the membranes (PPROM) may reduce the rate of infection and other disorders in the newborn baby. Researchers gave a five-day course of antibiotics or a placebo to 614 pregnant women who developed PPROM between 24 and 32 weeks gestation. The women who received antibiotics were less likely to deliver a baby with respiratory distress, a brain hemorrhage or severe bacterial infection compared to those who took a placebo. The incidence of fetal death was also lower in the women who took antibiotics.
Context. -- Intrauterine infection is thought to be one cause of preterm premature rupture of the membranes (PPROM). Antibiotic therapy has been shown to prolong pregnancy, but the effect on infant morbidity has been inconsistent. Objective. -- To determine if antibiotic treatment during expectant management of PPROM will reduce infant morbidity. Design. -- Randomized, double-blind, placebo-controlled trial. Setting. -- University hospitals of the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Patients. -- A total of 614 of 804 eligible gravidas with PPROM between 24 weeks' and 0 days' and 32 weeks' and 0 days' gestation who were considered candidates for pregnancy prolongation and had not received corticosteroids for fetal maturation or antibiotic treatment within 1 week of randomization. Interventions. -- Intravenous ampicillin (2-g dose every 6 hours) and erythromycin (250-mg dose every 6 hours) for 48 hours followed by oral amoxicillin (250-mg dose every 8 hours) and erythromycin base (333-mg dose every 8 hours) for 5 days vs a matching placebo regimen. Group B streptococcus (GBS) carriers were identified and treated. Tocolysis and corticosteroids were prohibited after randomization. Main Outcome Measures. -- The composite primary outcome included pregnancies complicated by at least one of the following: fetal or infant death, respiratory distress, severe intraventricular hemorrhage, stage 2 or 3 necrotizing enterocolitis, or sepsis within 72 hours of birth. These perinatal morbidities were also evaluated individually and pregnancy prolongation was assessed. Results. -- In the total study population, the primary outcome (44.1 % vs 52.9%; P=.04), respiratory distress (40.5% vs 48.7%; P=.04), and necrotizing enterocolitis (2.3% vs 5.8%; P=.03) were less frequent with antibiotics. in the GBS-negative cohort, the antibiotic group had less frequent primary outcome (44.5% vs 54.5%; P=.03), respiratory distress (40.8% vs 50.6%; P=.03), overall sepsis (8.4% vs 15.6%; P=.01), pneumonia (2.9% vs 7.0%; P=.04), and other morbidities. Among GBS-negative women, significant pregnancy prolongation was seen with antibiotics (P[less than]01). Conclusions. -- We recommend that women with expectantly managed PPROM remote from term receive antibiotics to reduce infant morbidity. JAMA. 1997;278:989-995