Azithromycin vs erythromycin for the management of preterm premature rupture of membranes

Abstract

BACKGROUND: Preterm premature rupture of membranes complicates 2e3% of pregnancies. Many institutions have advocated for the use of azithromycin instead of erythromycin. This is secondary to national shortages of erythromycin, ease of administration, better side effect profile, and decreased cost of azithromycin as compared with erythromycin. OBJECTIVE: The objective of the study was to evaluate whether there are differences in the latency from preterm premature rupture of membranes to delivery in patients treated with different dosing regimens of azithromycin vs erythromycin. STUDY DESIGN: This is a multicenter, retrospective cohort of women with singleton pregnancies with confirmed rupture of membranes between 23 0 and 33 6 weeks from January 2010 to June 2015. Patients were excluded if there was a contraindication to expectant management of preterm premature rupture of membranes. Patients received 1 of 4 antibiotic regimens: (1) azithromycin 1000 mg per os once (azithromycin 1 day group); (2) azithromycin 500 mg per os once, followed by azithromycin 250 mg per os daily for 4 days (azithromycin 5 day group); (3) azithromycin 500 mg intravenously for 2 days, followed by azithromycin 500 mg per os daily for 5 days (azithromycin 7 day group); or (4) erythromycin intravenously for 2 days followed by erythromycin per os for 5 days (erythromycin group). The choice of macrolide was based on institutional policy and/or availability of antibiotics at the time of admission. In addition, all patients received ampicillin intravenously for 2 days followed by amoxicillin per os for 5 days. Primary outcome was latency from diagnosis of rupture of membranes to delivery. Secondary outcomes included clinical and histopathological chorioamnionitis and neonatal outcomes. RESULTS: Four hundred fifty-three patients who met inclusion criteria were identified. Seventy-eight patients received azithromycin for 1 day,

Azithromycin in the Treatment of Preterm Prelabor Rupture of Membranes Demonstrates a Lower Risk of Chorioamnionitis and Postpartum Endometritis with an Equivalent Latency Period Compared with Erythromycin Antibiotic Regimens

“…Finneran et al [ 7 ] also found no difference in pregnancy latency but noted a higher rate of cesarean delivery and positive neonatal blood cultures in those patients who received erythromycin for prophylaxis. Navathe et al [ 8 ], when looking at patients who received a similar regimen to Pierson et al, Finneran et al, and this present study, found no differences in pregnancy latency, incidence of chorioamnionitis, or neonatal outcomes.…”

“…The traditional and originally described regimen for prophylaxis of chorioamnionitis and increased pregnancy latency was outlined first by Mercer et al [ 5 ] and involves intravenous ampicillin 2 g every 6 hours and erythromycin 250 mg every 6 hours for 48 hours followed by oral amoxicillin 250 mg every 8 hours and erythromycin 333 mg every 8 hours for five days. Presently, there are 3 retrospective studies [ 6 – 8 ] investigating the substitution of azithromycin for erythromycin in the setting of PPROM, each with unique conclusions and dosing strategies of each antibiotic: Pierson et al [ 6 ] found no differences in latency from membrane rupture as well as no difference in secondary maternal and neonatal outcomes. Finneran et al [ 7 ] also found no difference in pregnancy latency but noted a higher rate of cesarean delivery and positive neonatal blood cultures in those patients who received erythromycin for prophylaxis.…”

Cellular immune responses in amniotic fluid of women with preterm prelabor rupture of membranes

“…Hence, it is now established that pPROM can occur in the presence of either intra-amniotic infection [detectable microorganisms in amniotic fluid in the presence of an elevated concentration of IL-6 (≥2.6 ng/mL)] or sterile intra-amniotic inflammation (elevated concentration of IL-6 in the absence of detectable microorganisms), or even in the absence of intra-amniotic inflammation (IL-6 concentration <2.6 ng/mL) [38]. The standard of care for women with pPROM includes antibiotic administration [40][41][42][43][44][45]; however, it should also be considered that the intensity of the intra-amniotic inflammatory response is associated with the severity of fetal inflammation [37,38,[46][47][48]. Indeed, neonates born to women with pPROM and intraamniotic infection are at a higher risk of neonatal morbidity than those born to women with intra-amniotic inflammation [37,38,47].…”

Antibiotic prophylaxis in preterm rupture of membranes

“…Recently two other studies have compared the use of erythromycin or azithromycin associated with ampicillin followed by amoxicillin, primarily by assessing the latency period. 28,29 Both researches did not reveal significant differences in relation to the latency period, as well as maternal and neonatal morbidities, thus suggesting that the use of azithromycin could be an option in the management of PPROM.…”