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Antibiotics for Preterm Rupture of the Membranes: A Systematic Review

Kenyon, Sara RM*; Boulvain, Michel MD, PhD; Neilson, Jim MD

doi: 10.1097/01.AOG.0000143268.36682.21

OBJECTIVE: We sought to evaluate the administration of antibiotics to pregnant women with preterm rupture of membranes (PROM).

DATA SOURCES: We collected data by using the Cochrane Controlled Trials Register and MEDLINE.

METHODS OF STUDY SELECTION: We included randomized controlled comparisons of antibiotic versus placebo (14 trials, 6,559 women).

TABULATION, INTEGRATION, AND RESULTS: Antibiotics were associated with a statistically significant reduction in maternal infection and chorioamnionitis. There also was a reduction in the number of infants born within 48 hours and 7 days and with the following morbidities: neonatal infection (relative risk [RR] 0.67, 95% confidence interval [CI] 0.52–0.85), positive blood culture (RR 0.75, 95% CI 0.60–0.93), use of surfactant (RR 0.83 95% CI 0.72–0.96), oxygen therapy (RR 0.88, 95% CI 0.81–0.96), and abnormal cerebral ultrasound scan before discharge from hospital (RR 0.82, 95% CI 0.68–0.99). Perinatal mortality was not significantly reduced (RR 0.91, 95% CI 0.75–1.11). A benefit was present both in trials where penicillins and erythromycin were used. Amoxicillin/clavulanate was associated with a highly significant increase in the risk of necrotizing enterocolitis (RR 4.60, 95% CI 1.98–10.72).

CONCLUSION: The administration of antibiotics after PROM is associated with a delay in delivery and a reduction in maternal and neonatal morbidity. These data support the routine use of antibiotics for women with PROM. Penicillins and erythromycin were associated with similar benefits, but erythromycin was used in larger trials and, thus, the results are more robust. Amoxicillin/clavulanate should be avoided in women at risk of preterm delivery because of the increased risk of neonatal necrotizing enterocolitis. Antibiotic administration after PROM is beneficial for both women and neonates.

The administration of antibiotics after preterm rupture of membranes is beneficial for women and neonates.

From the *Department of Obstetrics and Gynaecology, University of Leicester, United Kingdom; †Department of Obstetrics and Gynecology, University of Geneva, Switzerland; and ‡Department of Obstetrics and Gynaecology, University of Liverpool, United Kingdom.

Address reprint requests to: Michel Boulvain, Maternité-HUG, Geneva 14, CH-1211, Switzerland; e-mail:

Received April 20, 2004. Received in revised form July 16, 2004. Accepted July 28, 2004.

© 2004 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.