• About Us
    • Contact Us
    • Login
    • ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
About Us Contact Us Login ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
Grand Rounds

Non-Penicillin Regimen for PPROM: What are the Outcomes?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Siegel et al. (American Journal of Perinatology Reports, 2019) examined the impact of non-penicilllin (PCN) regimens on neonatal outcomes

METHODS:

  • Secondary analysis of an RCT
    • Beneficial Effects of Antenatal Magnesium sulfate (BEAM) study (NICHD MFMU): Study aim was to assess use of magnesium sulfate for prevention of cerebral palsy
  • Participants
    • Singleton, nonanomalous pregnancy
    • Enrollment ≥24w0d | Delivery <35w0d
  • Interventions
    • Standard of care: 7-day course of PCN and macrolide (NICHD ‘gold standard’ – see ‘Related ObG Topics’ below)
    • Non-β-lactam regimen and a macrolide (NPCR)
  • Primary outcome
    • Composite of neonatal outcomes
      • NEC | Severe IVH | PVL | Bronchopulmonary dysplasia | Neonatal death prior to hospital discharge | Sepsis | Cerebral palsy
  • Secondary outcomes
    • Separate components of composite neonatal outcomes
    • Pregnancy latency (days from rupture to delivery)
    • Endometritis
    • Chorioamnionitis

RESULTS:

  • A total of 949 women
    • Standard care: 56%
    • NPCR: 8.8% | Within NPCR group, 64.1% received clindamycin
  • No difference in primary outcome between NPCR vs standard care
    • Adjusted odds ratio (aOR) 0.50 (95% CI, 0.22 to 1.11)
  • Neonates receiving standard care were
    • Less likely to have bronchopulmonary dysplasia (p=0.03)
    • More likely to have severe necrotizing enterocolitis (p=0.04)
  • Maternal outcomes
    • No difference between groups for chorioamnionitis and median latency
    • Endometritis risk was reduced with use of standard care
      • aOR 0.35; 95% CI 0.14 to 0.91

CONCLUSION:

  • Non-PCN regimens
    • Did not differ from gold standard regimen for composite neonatal outcome or latency
    • Increased the risk for endometritis
    • Increased the risk for bronchopulmonary dysplasia
  • Further studies are needed to follow up on current findings and to assess differences in individual neonatal morbidities
  • The authors state that

practitioners should appropriately use cephalosporins in patients with a nonsignificant PCN allergy and should consider PCN allergy testing in all pregnant women with significant allergies to optimize maternal and neonatal outcomes in pregnancies affected by PPROM in the setting of PCN allergy

Learn More – Primary Sources:

The Effect of Non-penicillin Antibiotic Regimens on Neonatal Outcomes in Preterm Premature Rupture of Membranes

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

Try it Free »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

ACOG Guidance Update: Diagnosis and Management of PROM (Prelabor Rupture of Membranes)
Do Common Antibiotics Increase Risk of Congenital Malformations?
How Do Alternative Antibiotics Regimens to Prevent Surgical Site Infection Following Cesarean Section compare to Cefazolin?
Can Azithromycin be Used as an Alternative to Erythromycin for PPROM?

Sections

  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • COVID-19

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

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.

Disclaimer

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

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site