Abstract
Objective
To review the evidence and provide recommendations on the use of antibiotics in preterm
premature rupture of the membranes (PPROM).
Outcomes
Outcomes evaluated include the effect of antibiotic treatment on maternal infection,
chorioamnionitis, and neonatal morbidity and mortality.
Evidence
Published literature was retrieved through searches of Medline, EMBASE, CINAHL, and
The Cochrane Library, using appropriate controlled vocabulary and key words (PPROM,
infection, and antibiotics). Results were restricted to systematic reviews, randomized
control trials/controlled clinical trials, and observational studies. There were no
date or language restrictions. Searches were updated on a regular basis and new material
incorporated in the guideline to July 2008. Grey (unpublished) literature was identified
through searching the websites of health technology assessment and health technology
assessment-related agencies, clinical practice guideline collections, clinical trial
registries, and national and international medical specialty societies.
Values
The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee
of the Society of Obstetricians and Gynaecologists of Canada (SOGC) under the leadership
of the principal authors, and recommendations were made according to guidelines developed
by the Canadian Task Force on Preventive Health Care.
Benefits, Harms, and Costs
Guideline implementation should assist the practitioner in developing an approach
to the use of antibiotics in women with PPROM. Patients will benefit from appropriate
management of this condition.
Validation
This guideline has been reviewed and approved by the Infectious Diseases Committee
and the Maternal Fetal Medicine Committee of the SOGC, and approved by the Executive
and Council of the SOGC.
Sponsor
The Society of Obstetricians and Gynaecologists of Canada.
Recommendations
- 1.Following PPROM at 32 weeks' gestation, antibiotics should be administered to women who are not in labour in order to prolong pregnancy and to decrease maternal and neonatal morbidity (I-A).
- 2.The use of antibiotics should be gestational-age dependent. The evidence for benefit is greater at earlier gestational ages (<32 weeks) (I-A).
- 3.For women with PPROM at >32 weeks' gestation, administration of antibiotics to prolong pregnancy is recommended if fetal lung maturity cannot be proven and/or delivery is not planned (I-A).
- 4.Antibiotic regimens may consist of an initial parenteral phase followed by an oral phase, or may consist of only an oral phase (I-A).
- 5.Antibiotics of choice are penicillins or macrolide antibiotics (erythromycin) in parenteral and/or oral forms. (I-A) In patients allergic to penicillin, macrolide antibiotics should be used alone (III-B).
- 6.The following two regimens may be used (the two regimens were used in the largest PPROM randomized controlled trials that showed a decrease in both maternal and neonatal morbidity): (1) ampicillin2g IV every 6 hours and erythromycin 250 mg IV every 6 hours for 48 hours followed by amoxicillin 250 mg orally every 8 hours and erythromycin 333 mg orally every 8 hours for 5 days (I-A); (2) erythromycin 250 mg orally every 6 hours for 10 days (I-A).
- 7.Amoxicillin/clavulanic acid should not be used because of an increased risk of necrotizing enterocolitis in neonates exposed to this antibiotic. Amoxicillin without clavulanic acid is safe (I-A).
- 8.Women presenting with PPROM should be screened for urinary tract infections, sexually transmitted infections, and group B streptococcus carriage, and treated with appropriate antibiotics if positive (II-2B).
Key Words
Abbreviations:
IUI (intrauterine infection), NEC (necrotizing enterocolitis), PPROM (preterm premature rupture of the membranes), RDS (respiratory distress syndrome)To read this article in full you will need to make a payment
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Article info
Publication history
No. 233, September 2017
Footnotes
This clinical practice guideline has been prepared by the Infectious Diseases Committee, reviewed by the Maternal Fetal Medicine Committee,
∗
and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada.Infectious Diseases Committee: Mark H. Yudin (Chair), MD, Toronto, ON; Marc Boucher, MD, Montréal, QC; Eliana Castillo, MD, Vancouver, BC; Beatrice Cormier, MD, Montréal, QC; Andrée Gruslin, MD, Ottawa, ON; Deborah M. Money, MD, Vancouver, BC; Kellie Murphy, MD, Toronto, ON; Gina Ogilvie, MD, Vancouver, BC; Caroline Paquet, RM, Trois-Rivières, QC; Audrey Steenbeek, RN, Halifax, NS; Nancy Van Eyk, MD, Halifax, NS; Julie van Schalkwyk, MD, Vancouver, BC; Thomas Wong, MD, Ottawa, ON. Maternal Fetal Medicine Committee: Robert Gagnon (Chair), MD, Montréal, QC; Lynda Hudon (Co-Chair), MD, Montréal, QC; Melanie Basso, RN, Vancouver, BC; Hayley Bos, MD, London, ON; Marie-France Delisle, MD, Vancouver, BC; Dan Farine, MD, Toronto, ON; Kirsten Grabowska, MD, Vancouver, BC; Savas Menticoglou, MD, Winnipeg, MB; William Robert Mundle, MD, Windsor, ON; Lynn Carole Murphy-Kaulbeck, MD, Allison, NB; Annie Ouellet, MD, Sherbrooke, QC; Tracy Pressey, MD, Vancouver, BC; Anne Roggensack, MD, Calgary, AB. Disclosure statements have been received from all members of the committees.
Identification
Copyright
© 2017 Published by Elsevier Inc. on behalf of The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada
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- No 233-Antibiothérapie et rupture prématurée des membranes prétermeJournal of Obstetrics and Gynaecology Canada Vol. 39Issue 9
