Antibiotic regimens for management of intra-amniotic infection

Abstract

This review included 11 studies (having low to moderate risk of bias). The quality of the evidence was low to very low for most outcomes, as per the GRADE approach. Only one outcome (duration of hospital stay) was considered to provide moderate quality of evidence when antibiotics (short duration) were compared with antibiotics (long duration) during postpartum management of intra-amniotic infection. Our main reasons for downgrading the quality of evidence were limitations in study design or execution (risk of bias), imprecision, and inconsistency of results.Currently, limited evidence is available to reveal the most appropriate antimicrobial regimen for the treatment of patients with intra-amniotic infection; whether antibiotics should be continued during the postpartum period; and which antibiotic regimen or what treatment duration should be used. Also, no evidence was found on adverse effects of the intervention (not reported in any of the included studies). One small RCT showed that use of antibiotics during the intrapartum period is superior to their use during the postpartum period in reducing the number of days of maternal and neonatal hospital stay.

The placental membrane microbiome is altered among subjects with spontaneous preterm birth with and without chorioamnionitis

“…Common treatment for chorioamnionitis includes ampicillin, gentamicin, and clindamycin. 66,67 A recent study, however, examined treatment with an antibiotic regimen of ceftriaxone, clarithromycin, and metro-nidazole, which the authors found reduced histologic chorioamnionitis and funisitis. 68 Therefore, further investigation is necessary to understand how antibiotics may or may not alter the placental membrane microbiome.…”

Citation analysis as a literature search method for systematic reviews

“…A cursory review of cocited articles that were highly cited by articles citing the key articles retrieved additional potentially relevant publications that were not cited by the review authors in three reviews: Chapman et al (2014), Marshall et al (2014), andParekh et al (2014). In the case of Chapman et al (2014), the proposed method retrieved Sperling, Ramamurthy, and Gibbs (1987) and Gilstrap et al (1988); in the case of Marshall et al (2014), the method retrieved Roten, Baker, and Gray (2013); and in the case of Parekh et al (2014), the method retrieved Littlejohn, Tarling, Flynn, Ordman, and Aiken (1996). Although these publications may have been retrieved and subsequently excluded by the authors of these reviews, it is also possible that they were not retrieved at all.…”

“…The accuracy rate per review also improves substantially, ranging from 70% in the case of Parekh et al (2014) to 100% in the cases of Jackson, Veeratterapillay, Harding, and Dorkin (2014), Liu et al (2014), Mackeen et al (2014), Maguire, Weston, Singh, and Marson (2014), McNab et al (2014), Rimmer et al (2014), and Song et al (2014). The method missed a single study in the cases of Day et al (2014), Flowers, Hartley, Todkill, Stranges, andRees (2014), Marshall, Gowing, Ali, andLe Foll (2014), andMcRobbie, Bullen, Hartmann-Boyce, andHajek (2014), two studies in the cases of Chapman, Reveiz, Illanes, and Bonfill Cosp (2014) and Tan et al (2014), and three studies in the case of Parekh et al (2014).…”

“…Article title Chapman et al (2014) Antibiotic regimens for management of intra-amniotic infection Day et al (2014) Interventions for preventing and ameliorating cognitive deficits in adults treated with cranial irradiation Flowers et al (2014) Co-enzyme Q10 supplementation for the primary prevention of cardiovascular disease Jackson et al (2014) Intermittent self-dilatation for urethral stricture disease in males Liu et al (2014) Robot-assisted surgery in gynaecology Mackeen et al (2014) Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery Maguire et al (2014) Antidepressants for people with epilepsy and depression Marshall et al (2014) Pharmacotherapies for cannabis dependence McNab et al (2014) Isotonic versus hypotonic solutions for maintenance intravenous fluid administration in children McRobbie et al (2014) Electronic cigarettes for smoking cessation and reduction Parekh et al (2014) Intraoperative local anaesthesia for reduction of postoperative pain following general anaesthesia for dental treatment in children and adolescents Rimmer et al (2014) Surgical versus medical interventions for chronic rhinosinusitis with nasal polyps Song et al (2014) Long-term proton pump inhibitor (PPI) use and the development of gastric pre-malignant lesions. Tan et al (2014) Immunonutrition as an adjuvant therapy for burns…”

“…Although the method retrieved more records than three of the reviews- Mackeen et al (2014), Song et al (2014), and Tan et al (2014)-it retrieved an equivalent number or fewer records than 11 of these reviews. In 5 of these 11 reviews- Chapman et al (2014), Day et al (2014), Liu et al (2014), Marshall et al (2014), and Rimmer et al (2014)-it retrieved substantially fewer records. Of course, the higher precision achieved by the proposed method comes at the cost of reduced recall.…”