Antibiotic treatment of preterm labor with intact membranes: A multicenter, randomized, double-blinded, placebo-controlled trial

Romero, Roberto; Sibai, Baha M.; Caritis, Steve N.; Paúl, Richard; Depp, Richard; Rosen, Mortimer G.; Klebanoff, Mark A.; Sabo, Virginia; Evans, Joni K.; Thom, Elizabeth; Cefalo, Robert C.; McNellis, Donald

doi:10.1016/0002-9378(93)90003-2

Cited by 124 publications

(44 citation statements)

References 17 publications

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“…Therefore, if the goal of antibiotic administration is to reduce preterm labor and delivery, this can only be accomplished by preventing infection-induced preterm labor and delivery. 94,95 Consequently, randomized clinical trials designed to test hypotheses must identify patients at risk for infection, and such risks must be substantial in order for the trial to have a reasonable expectation of success.…”

mentioning

confidence: 99%

“…For antibiotics to be effective in reducing the rate of preterm delivery, several criteria must be met: 95 (1) antimicrobials must be effective against the target organism or the clinical condition under study (eg, BV); (2) antimicrobials should be used only in women who can benefit because they are at substantial risk for infection or an infection-related condition; and (3) antimicrobials must be used early enough 117 so that eradication of the microorganisms would be followed by resolution of any inflammatory response 66,118,119 and its unintended consequences (eg, damage of the chorioamniotic membranes, microbial invasion of the amniotic cavity, fetal microbial invasion, and fetal inflammation). 120–122 …”

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confidence: 99%

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Treatment of abnormal vaginal flora in early pregnancy with clindamycin for the prevention of spontaneous preterm birth: a systematic review and metaanalysis

Lamont¹,

Nhan-Chang²,

Sobel³

et al. 2011

American Journal of Obstetrics and Gynecology

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161

139

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The purpose of this study was to determine whether the administration of clindamycin to women with abnormal vaginal flora at <22 weeks of gestation reduces the risk of preterm birth and late miscarriage. We conducted a systematic review and metaanalysis of randomized controlled trials of the early administration of clindamycin to women with abnormal vaginal flora at <22 weeks of gestation. Five trials that comprised 2346 women were included. Clindamycin that was administered at <22 weeks of gestation was associated with a significantly reduced risk of preterm birth at <37 weeks of gestation and late miscarriage. There were no overall differences in the risk of preterm birth at <33 weeks of gestation, low birthweight, very low birthweight, admission to neonatal intensive care unit, stillbirth, peripartum infection, and adverse effects. Clindamycin in early pregnancy in women with abnormal vaginal flora reduces the risk of spontaneous preterm birth at <37 weeks of gestation and late miscarriage. There is evidence to justify further randomized controlled trials of clindamycin for the prevention of preterm birth. However, a deeper understanding of the vaginal microbiome, mucosal immunity, and the biology of bacterial vaginosis will be needed to inform the design of such trials.

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confidence: 99%

mentioning

confidence: 99%

Treatment of abnormal vaginal flora in early pregnancy with clindamycin for the prevention of spontaneous preterm birth: a systematic review and metaanalysis

Lamont¹,

Nhan-Chang²,

Sobel³

et al. 2011

American Journal of Obstetrics and Gynecology

Self Cite

161

139

View full text Add to dashboard Cite

show abstract

“…Multiple studies have evaluated the role of antibiotics to treat preterm labor, without compelling data to support their use when membranes are intact. In the largest multicenter, randomized, double-blinded, placebo-controlled trial, 277 women were randomized to ampicillinamoxicillin and erythromycin (133 patients) versus placebo (144 patients) [52]. The study investigators failed to show a difference in randomization to delivery interval, preterm delivery, preterm premature rupture of membranes (PPROM), chorioamnionitis, endometritis, and neonatal outcomes [52].…”

Section: Antibioticsmentioning

confidence: 98%

Prematurity prevention: the role of acute tocolysis

Blumenfeld

Lyell

2009

Current Opinion in Obstetrics &Amp; Gynecology

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All tocolytic medications have side-effects, some of them potentially life-threatening. Decisions regarding whether to use a tocolytic and which tocolytic to use require the diagnosis of preterm labor, knowledge of the patient's gestational age, medical conditions, and cost. Once tocolysis is initiated, attention must be paid to the patient's response, side-effects, and adverse events. Larger studies are needed which incorporate, in addition to efficacy, data on safety and side-effect profiles and cost.

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“…54 However, randomised placebo controlled trials on the use of antibiotics in the treatment of preterm labour have not shown bene®ts such as increased gestation at delivery or increased birth weight. 55,56 Women treated in early gestation may have recolonisation. Inaccuracy of diagnosis or overdiagnosis may be blamed for antibiotics being unsuccessful.…”

Section: Adjunctive Management To Cerclagementioning

confidence: 98%