264: Comparison of ampicillin/sulbactam versus ampicillin/gentamicin for treatment of intrapartum chorioamnionitis: a randomized controlled trial

Greenberg, Mara; Yeaton-Massey, Amanda; Hazard, Kimberly; Dougall, Kirstin; Yoffe, Paula; Benitz, William Ε.; El‐Sayed, Yasser Y.; Aziz, Najib

doi:10.1016/j.ajog.2014.10.310

Cited by 4 publications

(8 citation statements)

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“…The definition of chorioamnionitis was based on Gibbs' criteria 3 in 9 of the 14 studies 14,16‐22,27 . In three of the 14 trials, 15,23,24 chorioamnionitis was defined as maternal fever (≥38°C) in labor and in two trials, where no full text was available, the definition was not specified 25,26 . Six of the 14 trials compared different antibiotic regimens that were initiated intrapartum; 14,15,20‐22,25 these trials compared different types of antibiotic regimens 15,20,25 or different doses of the same antibiotic 14,21,22 .…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies were assessed as having moderate‐to‐high risk of bias, 14‐21,23,27 based on concerns with regard to randomization, blinding, and selective reporting in outcomes. Three studies, where only conference abstracts were available, were assessed as having unclear risk of bias 24‐26 . Only one study 22 was assessed as having a low risk of bias; this study was registered at clinicaltrials.gov and reported prespecified outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…14,[16][17][18][19][20][21][22]27 In three of the 14 trials, 15,23,24 chorioamnionitis was defined as maternal fever (≥38°C) in labor and in two trials, where no full text was available, the definition was not specified. 25,26 Six of the 14 trials compared different antibiotic regimens that were initiated intrapartum; 14,15,[20][21][22]25 these trials compared different types of antibiotic regimens 15,20,25 or different doses of the same antibiotic. 14,21,22 Seven of the 14 trials assessed the use of antibiotics given immediately after delivery.…”

Section: General Characteristics Of the Studiesmentioning

confidence: 99%

“…Finally, one trial compared intrapartum vs postpartum initiation of the same antibiotic regimen. 27 The primary outcomes as reported in the included studies were "treatment failure" (definitions included in Table 1) in three studies, [22][23][24] cure rate or treatment success in three studies, 13,14,18 incidence of endometritis in five studies, 16,17,20,25,26 duration of maternal hospital stay and fetal and maternal peak of gentamicin in one study 21 and neonatal sepsis in the study that compared intrapartum vs postpartum initiation of treatment. 19 The primary and secondary outcomes of each study are described in Table 1.…”

Section: General Characteristics Of the Studiesmentioning

confidence: 99%

“…Three studies, where only conference abstracts were available, were assessed as having unclear risk of bias. [24][25][26] Only…”

Section: Risk Of Bias Of Included Studiesmentioning

confidence: 99%

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Determining the optimal antibiotic regimen for chorioamnionitis: A systematic review and meta‐analysis

Alrowaily

D’Souza

Dong

et al. 2021

Acta Obstet Gynecol Scand

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Introduction To evaluate the effect of antibiotic regimens for chorioamnionitis on maternal and neonatal outcomes. Material and methods We conducted a systematic review, wherein we searched six bibliographic databases until June 2020 and included randomized clinical trials describing antibiotic regimens for treating chorioamnionitis. Risk of bias was assessed using the Cochrane Risk of Bias tool V2.0. Random‐effects meta‐analysis was performed and results were presented as risk ratio (RR) and mean differences (MD) with 95% CI. Results Fourteen trials at low‐to‐high risk of bias were included. Three trials (n = 244), comparing different intrapartum antibiotic regimens, showed no difference in outcomes except for lower composite maternal morbidity (endometritis, pneumonia, sepsis, blood transfusion, and ileus) with ampicillin/sulbactam vs ampicillin/gentamicin in one study (0/43 vs 6/49, P = .03). Three trials (n = 295) comparing different doses of intrapartum antibiotics showed no differences in maternal and neonatal outcomes, although one study showed a shorter duration of antibiotic treatment in the experimental arm (4 mg/kg gentamicin q24h + 1200 mg clindamycin q12h) vs conventional arm (1.33 mg/kg gentamicin + 800 mg clindamycin q8h) (48.0 ± 36 hours vs 55.2 ± 48 hours, P = .04). Four trials (n = 484) comparing postpartum antibiotics vs no antibiotics showed no difference in outcomes except for a shorter hospital stay (two studies, MD −7.90 hours, 95% CI −13.52 to −2.27 hours). Three trials (n = 447) comparing single vs multiple doses of postpartum antibiotics showed shorter hospital stay [MD −19.14 hours, 95% CI −29.88 to −8.41 hours), but no differences in treatment failure (RR 1.73, 95% CI 0.69‐4.30) or total antibiotic dose (MD −9.24, 95% CI −19.49 to 1.01). One trial (n = 48) comparing intrapartum vs postpartum initiation of treatment found benefits to intrapartum (vs postpartum) initiation of antibiotics, in terms of postpartum maternal hospital stay (MD −24 hours, 95% CI −45.56 to −1.44 hours), neonatal hospital stay (MD −45.6 hours, −93.84 to −11.76 hours), and neonatal pneumonia or sepsis (RR 0.06, 95% CI 0.00‐0.95). Conclusions Upon diagnosis of chorioamnionitis, there is limited evidence to recommend the prompt initiation of intrapartum antibiotics, and to consider a single dose of postpartum antibiotics over multiple doses or no treatment. Well‐designed trials using standard definitions of chorioamnionitis, outcome measures, and newer antibiotics are required to inform clinical practice with regard to the preferred antibiotic regimen, dose, and duration to optimize maternal and neonatal outcomes.

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