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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Matern+Fetal+Neonatal+Med
2016 ; 29
(5
): 707-20
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
A new anti-microbial combination prolongs the latency period, reduces acute
histologic chorioamnionitis as well as funisitis, and improves neonatal outcomes
in preterm PROM
#MMPMID26373262
Lee J
; Romero R
; Kim SM
; Chaemsaithong P
; Park CW
; Park JS
; Jun JK
; Yoon BH
J Matern Fetal Neonatal Med
2016[Mar]; 29
(5
): 707-20
PMID26373262
show ga
OBJECTIVE: Antibiotic administration is a standard practice in preterm premature
rupture of membranes (PROM). Specific anti-microbial agents often include
ampicillin and/or erythromycin. Anaerobes and genital mycoplasmas are frequently
involved in preterm PROM, but are not adequately covered by antibiotics routinely
used in clinical practice. Our objective was to compare outcomes of PROM treated
with standard antibiotic administration versus a new combination more effective
against these bacteria. STUDY DESIGN: A retrospective study compared perinatal
outcomes in 314 patients with PROM <34 weeks receiving anti-microbial regimen 1
(ampicillin and/or cephalosporins; n?=?195, 1993-2003) versus regimen 2
(ceftriaxone, clarithromycin and metronidazole; n?=?119, 2003-2012).
Intra-amniotic infection/inflammation was assessed by positive amniotic fluid
culture and/or an elevated amniotic fluid MMP-8 concentration (>23?ng/mL).
RESULTS: (1) Patients treated with regimen 2 had a longer median
antibiotic-to-delivery interval than those with regimen 1 [median (interquartile
range) 23?d (10-51?d) versus 12?d (5-52?d), p?0.01]; (2) patients who received
regimen 2 had lower rates of acute histologic chorioamnionitis (50.5% versus
66.7%, p?0.05) and funisitis (13.9% versus 42.9%, p?0.001) than those who had
received regimen 1; (3) the rates of intra-ventricular hemorrhage (IVH) and
cerebral palsy (CP) were significantly lower in patients allocated to regimen 2
than regimen 1 (IVH: 2.1% versus 19.0%, p?0.001 and CP: 0% versus 5.7%,
p?0.05); and (4) subgroup analysis showed that regimen 2 improved perinatal
outcomes in pregnancies with intra-amniotic infection/inflammation, but not in
those without intra-amniotic infection/inflammation (after adjusting for
gestational age and antenatal corticosteroid administration). CONCLUSION: A new
antibiotic combination consisting of ceftriaxone, clarithromycin, and
metronidazole prolonged the latency period, reduced acute histologic
chorioamnionitis/funisitis, and improved neonatal outcomes in patients with
preterm PROM. These findings suggest that the combination of anti-microbial
agents (ceftriaxone, clarithromycin, and metronidazole) may improve perinatal
outcome in preterm PROM.