BACKGROUND AND PURPOSE:

• US PPROM recommendations (see ‘Related ObG Topics’, below)
  • IV ampicillin [2 g every 6 hours] and erythromycin [250 mg every 6 hours] for 48 hours followed by oral amoxicillin [250 mg every 8 hours] and erythromycin base [333 mg every 8 hours] for an additional 5 days (7 days total)
• Azithromycin has the following benefits compared to erythromycin
  • Fewer side effects | Cheaper | Availability
• Navathe et al. (AJOG, 2019) compared erythromycin and azithromycin for PPROM

METHODS:

• Multicenter, retrospective cohort study
• Participants
  • Singleton pregnancies | Confirmed PROM | 23w0d -33w6d
• Antibiotic regimens
  • Azithromycin 1 day group: Azithromycin 1000 mg po once
  • Azithromycin 5 day group: Azithromycin 500 mg po once, followed by azithromycin 250 mg po daily for 4 days
  • Azithromycin 7 day group: Azithromycin 500 mg IV for 2 days, followed by azithromycin 500 mg po daily for 5 days
  • Erythromycin group: IV for 2 days followed by erythromycin po for 5 days
• Regimen based on institutional policy and/or medication availability
• All patients received ampicillin IV for 2 days followed by amoxicillin po for 5 days
• Primary outcome
  • Latency from PPROM to delivery
• Secondary outcomes
  • Chorioamnionitis | GA at delivery | Vaginal delivery | Stillbirth
  • Neonatal outcomes (e.g., IVH, NEC, RDS, sepsis, death)

RESULTS:

• 453 patients met inclusion criteria
  • Median GA at delivery: 30 weeks
• No difference in median latency of azithromycin groups compared to erythromycin after adjusting for demographic variables (P=0.99)
  • Azithromycin 1 day: 4.9 days for (95% CI, 3.3–6.4)
  • Azithromycin 5 days: 5.0 days for (95% CI, 3.9–6.1)
  • Azithromycin 7 days: 4.9 days for (95% CI, 2.8–7.0)
  • Erythromycin: (5.1 days for 95% CI, 3.9–6.4)
• No difference in secondary outcomes, including chorioamnionitis except for RDS
  • RDS was more common in azithromycin 5 day group (44%) compared to the azithromycin 1 day group (29%) and the erythromycin group (29%) ; P=0.005

CONCLUSION:

• There was no difference in primary outcome (latency) or other secondary outcomes except for RDS in the 5 day azithromycin group
• The authors suggest that azithromycin is a potential alternative for PPROM treatment if erythromycin is not an option (contraindicated or unavailable)

Learn More – Primary Sources:

Azithromycin vs erythromycin for the management of preterm premature rupture of membranes

Related ObG Topics:

ACOG Guidance Update: Diagnosis and Management of PROM (Prelabor Rupture of Membranes)

Should Tocolytics Be Used Following PPROM?

What is the Best Course of Action Following PPROM Between 24 and 37 Weeks?

Can Azithromycin Be Used in Place of Erythromycin for Preterm PROM?