Antibiotic prophylactic combo improves pregnancy outcomes in PPROM
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For women with preterm pre-labor rupture of membranes, treatment with cefuroxime- vs. ampicillin-roxithromycin was associated with longer pregnancy and less morbidity, according to a presenter at The Pregnancy Meeting.
“Currently, ampicillin is the recommended prophylactic antibiotic for [preterm pre-labor rupture of membranes] by ACOG,” Maya Frank Wolf, MD, of the Galilee Medical Center at Bar-Ilan University in HaZafon, Israel, said during the presentation. “Therefore, we decided to compare the efficacy of ampicillin vs. cefuroxime plus roxithromycin.”
Wolf and colleagues randomly assigned 124 women with preterm pre-labor rupture of membranes (PPROM) before 37 weeks’ gestation 1:1 to one of two roxithromycin combination regimens: one with ampicillin and one with cefuroxime. The researchers compared latency period length, adverse outcomes in neonates and maternal infectious morbidity between the two groups.
Compared with the ampicillin group, women in the cefuroxime group had lower rates of maternal infectious morbidity (17.7% vs. 6.5%; P = .048) and fewer bacteria from the Enterobacteriaceae family in samples of the placenta, membrane, umbilical cord and uterus (68.6% vs. 43.2%; P = .036).
There were no differences between groups for maternal outcomes including antenatal steroid administration, magnesium sulphate for neuroprotection, antepartum maternal fever, intrauterine infection and cesarean delivery.
Composite adverse outcome among neonates was lower in the cefuroxime group (P = .031), with three neonates in the ampicillin group having ampicillin-resistant early-onset neonatal sepsis. The cefuroxime group had no cases of early-onset neonatal sepsis.
Among women who were pregnant for the first time, those in the cefuroxime group were more likely to have a latency period longer than 4 days (OR = 3.69; 95% CI, 1.175-11.607).
“Despite the small sample size, and in light of the emerging rise in gram-negative ampicillin-resistant early-onset sepsis, broader antibiotic prophylactic regimens should be considered according to the distribution of regional pathogens,” Wolf said.