Preterm Premature Rupture of Membranes : Antibiotics
- Antibiotics are indicated to prolong latency and reduce the risk of
early onset neonatal group B streptococcal (GBS) infection, as well as
for treatment of overt intraamniotic infection, if present.
- The regimen
of prophylactic antibiotics is given for seven days to patients at
<34 weeks of gestation at the time of membrane rupture
Prophylaxis
- Infection may lead to spontaneous
preterm labor or may be the indication for medically-indicated preterm
delivery.
- The goal of antibiotic therapy is to reduce the frequency of
maternal and fetal infection and thereby delay the onset of preterm
labor (ie, prolong latency) and the need for preterm delivery
Rationale
- Ampicillin specifically targets group B streptococcus, many aerobic
gram-negative bacilli, and some anaerobes.
- Azithromycin specifically
targets Ureaplasmas, which can be important causes of chorioamnionitis in this setting.
- Azithromycin also provides coverage of Chlamydia trachomatis, which is an important cause of neonatal conjunctivitis and pneumonitis
References:
- NAG 2014
- www.uptodate.com
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964356/
- http://www.aafp.org/afp/2011/0501/p1106.html
- https://www.rcog.org.uk/en/guidelines-research-services/guidelines/preterm-prom-in-a-group-b-strep-positive-woman---query-bank/
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