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ANTIBIOTIC PROPHYLAXIS in Premature Rupture of Membranes

ANTIBIOTIC PROPHYLAXIS in Premature Rupture of Membranes. Dr. Geetha Balsarkar, Associate Professor and Unit incharge, Nowrosjee Wadia Maternity Hospital, Seth G.S. Medical college, Parel , Mumbai Joint Asst. Secretary to the Editor, Journal of Obstetrics and Gynecology of India,

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ANTIBIOTIC PROPHYLAXIS in Premature Rupture of Membranes

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  1. ANTIBIOTIC PROPHYLAXIS in Premature Rupture of Membranes

  2. Dr. Geetha Balsarkar, Associate Professor and Unit incharge, Nowrosjee Wadia Maternity Hospital, Seth G.S. Medical college, Parel , Mumbai Joint Asst. Secretary to the Editor, Journal of Obstetrics and Gynecology of India, Secretary, AMWI, Mumbai branch

  3. Premature birth carries substantial neonatal morbidity and mortality. Why? • subclinical infection • To whom? • Mother – chorioamnionitis • Fetus

  4. Flip side • Maternal antibiotic therapy might lessen infectious morbidity and delay labour, but could suppress labour without treating underlying infection.

  5. Cochrane data base • The use of antibiotics following pROM is associated with a statistically significant reduction in chorioamnionitis • There was a reduction in the numbers of babies born within 48 hours • The following markers of neonatal morbidity were reduced: neonatal infection, • use of surfactant • oxygen therapy • and abnormal cerebral ultrasound scan prior to discharge from hospital • Co-amoxiclav was associated with an increased risk of neonatal necrotising enterocolitis

  6. Conclusion • Antibiotic administration following pROM is associated with a delay in delivery and a reduction in major markers of neonatal morbidity. • These data support the routine use of antibiotics in pPROM. • The choice as to which antibiotic would be preferred is less clear as, by necessity, fewer data are available. • Co-amoxiclav should be avoided in women at risk of preterm delivery because of the increased risk of neonatal necrotising enterocolitis. • From the available evidence, erythromycin would seem a better choice.

  7. National Institute of Child Health and Human Development - Maternal Fetal Medicine Units (NICHD-MFMU) study of PROM and the ORACLE trial. • intravenous antibiotics were used for 48 hours—ampicillin 2 g q6h and erythromycin 250 mg q6h. The patients were then placed on oral amoxicillin 250 mg q8h and enteric-coated, erythromycin-base 333 mg q8h to complete a 7-day course of antibiotic therapy.

  8. Current evidence • 7 days of antibiotics, as proposed by the NICHD-MFMU study of PROM, should be the antibiotic regimen used in patients with PPROM who are being managed expectantly. • When another antibiotic is being used for other indications, such as a urinary tract infection, attempts should be made to avoid duplicated therapy. • For example, a patient being treated with a cephalosporin for a urinary tract infection does not need penicillin therapy. • Therapy longer than 7 days should be avoided; it has not been shown to be more effective and may promote the emergence of resistance organisms.

  9. Current evidence • Recommend routine prescription of macrolide antibiotics in this clinical situation. • The routine prescription of macrolide antibiotic (erythromycin) is recommended as beta lactum antibiotics (augmentin) is associated with a statistically significant increase in neonatal necrotising enterocolitis.

  10. Thank you

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