NEW research from the Galilee Medical Centre, Nahariya, Israel, suggests that females with preterm prelabour rupture of membranes (PPROM) who were treated with cefuroxime and roxithromycin had longer pregnancies that were associated with less morbidity.
Prophylactic antibiotic treatment following PPROM aims to reduce intra-amniotic infection and improve pregnancy outcomes. Ampicillin is currently the “recommended prophylactic antibiotic for PPROM by the American College of Obstetrics and Gynecologists (ACOG),” said Maya Frank Wolf, of the Galilee Medical Centre. However, ampicillin resistance has altered the epidemiology of neonatal sepsis. Thus, the research team decided to compare the efficacy of ampicillin plus roxithromycin versus cefuroxime plus roxithromycin treatment.
In total, 124 females with PPROM before 37 weeks were randomly assigned to one of two treatment groups. Both groups received roxithromycin, with the first group receiving ampicillin and the second receiving cefuroxime in conjunction. Adverse outcomes in neonates, maternal infectious morbidity, and latency period length were recorded and compared.
Females in the cefuroxime treatment group demonstrated several improved outcomes. Lower rates of maternal infectious morbidity were reported (17.7% versus 6.5%, p=0.048), along with fewer bacteria from the Enterobacteriaceae family in samples of the placenta, membrane, umbilical cord, and uterus (68.6% versus 43.2%, p=0.036). Finally, an increased number of females experiencing their first pregnancy had a latency period of 4 or more days in the cefuroxime group (odds ratio: 3.69; 95% confidence interval: 1.175–11.607). However, no significant difference was reported when comparing the incidence of antepartum maternal fever, caesarean delivery, intrauterine infection, antenatal steroid administration, and magnesium sulphate for neuroprotection.
When considering neonatal outcomes, composite adverse outcomes were less common in the cefuroxime group (p=0.031), whereas 3 neonates had ampicillin-resistant early onset neonatal sepsis in the ampicillin group.
Overall, cefuroxime plus roxithromycin treatment resulted in a longer latency period in first time pregnancies and less composite maternal and neonatal morbidity. Therefore, changing to broader prophylactic antibiotic treatment might improve neonatal and maternal outcomes in pregnancies that experience PPROM. Future research should focus on the feasibility of broad-spectrum antibiotic treatment for PPROM worldwide by utilising a larger sample-size.
