Antibiotics for PROM Near Term Have No Benefit

Antibiotics should not be given to pregnant women at or near term when their water breaks ahead of labor, according to an updated Cochrane analysis.

In re-evaluating the scientific evidence, researchers for the Cochrane Pregnancy and Childbirth Group determined that there is little support for the routine use of antibiotics when addressing prelabor rupture of membranes (PROM) at 36 weeks' gestation or later. A previous analysis in 2002 gave no clear clinical practice guidelines because of a lack of reliable data.

Pertinent Points

- Scientific evidence does not support giving antibiotics to women when addressing prelabor rupture of membranes at 36 weeks' gestation or later.

- Despite the quality of evidence being low, the researchers found no convincing evidence of any benefit to mother or child.

The latest recommendations continue to bemoan the quality of the scientific evidence, which is low, but go a step further to suggest that antibiotics not be used because there is no convincing evidence of a benefit to mother or child.

“We are unable to adequately assess the risk of short- and long-term harms from the use of antibiotics due to the unavailability of data,” the authors wrote. “Given the unmeasured potential adverse effects of antibiotic use, the potential for the development of resistant organisms, and the low risk of maternal infection in the control group, the routine use of antibiotics for PROM at or near term in the absence of confirmed maternal infection should be avoided.”

In reaching the recommendation, the editors reviewed four studies, adding two additional studies to what was previous included in the 2002 analysis. The additional data was significant because while previously there was a statistically significant reduction in endometritis with the use of antibiotics, no such effect was shown in the update (average risk ratio, 0.34; 95% confidence interval, 0.05 to 2.31). Furthermore, cesarean section was increased with the use of antibiotics, as was the duration of the maternal hospital stay, the authors noted.

Still, the researchers found no differences among women who did and didn’t receive antibiotics when it came to the primary outcome measures of probable early-onset neonatal sepsis, definite early-onset neonatal sepsis, maternal infectious morbidity, and perinatal mortality.