Can Azithromycin Be Used in Place of Erythromycin for Preterm PROM?
BACKGROUND AND PURPOSE:
Finneran et. al. (American Journal of Perinatology, 2017) assessed the impact of substituting a single dose of azithromycin in place of the standard erythromycin regimen used to prolong pregnancy in preterm PROM (PPROM)
Retrospective cohort study of 162 women with PPROM between 22 and 33 6/7 weeks
Subjects were categorized as:
Received standard antibiotic regimen (7 days of erythromycin and ampicillin/amoxicillin)
Received a single oral dose of azithromycin substituted for erythromycin in this regimen
latency from PPROM to delivery defined as the time of first antibiotic administration to delivery
Secondary outcomes included
rates of cesarean delivery, intrauterine infection (chorioamnionitis or funisitis), Apgar scores, positive neonatal blood cultures, respiratory distress syndrome, necrotizing enterocolitis, and neonatal death
Tocolytic therapy was more frequent in the azithromycin group compared with erythromycin group (33.3 vs. 16.7%, P = 0.01); otherwise, there were no differences in baseline characteristics
Tocolytic exposure was included in multivariate analysis
When comparing erythromycin to azithromycin
There was no difference median latency from PPROM to delivery (6.37 days vs 5.86 days, P = 0.67)
There was a higher rate of cesarean delivery (48.8 vs. 29.5%, P = 0.01)
There was an increased risk of neonatal sepsis (4.1 vs. 13.6%, P = 0.05)
Based on pathogens, unlikely to be related to antibiotic exposure
There was no difference in latency when azithromycin was substituted for erythromycin
Ease of single dose regimen and cost effectiveness may make azithromycin a good alternative to erythromycin in PPROM
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan