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
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