Mean length of latency in women with PPROM was similar between individuals treated with erythromycin and azithromycin
Erythromycin: 6.6 days
Azithromycin: 6.7 days
Mean difference 0.07 days (95% CI, −0.45 to 0.60)
Median point prevalence rates of clinical chorioamnionitis
Erythromycin: 25% (95% CI, 12 to 32)
Azithromycin: 14% (95% CI, 9 to 24)
The overall clinical chorioamnionitis rate in women treated with azithromycin was lower than women treated with erythromycin
Pooled OR: 0.53 (95% CI, 0.39 to 0.71)
Neonatal outcomes were similar between groups for the following
Neonatal sepsis | RDS | Perinatal death
Treating PPROM with azithromycin and erythromycin results in similar latency period
There was a lower rate of chorioamnionitis with azithromycin treatment
Limitations of the study include lack of any trials that randomized patients to one macrolide antibiotic vs the other
The authors state
Organizations involved in national guideline development weighing the harms and benefits in the context of the current strength of evidence available may consider revising the existing recommendation for the use of the macrolide erythromycin with PPROM to allow alternative macrolide regimens
However, until the result of prospective RCTs currently ongoing are available, contemporary guidelines recommend using erythromycin concurrently with a beta-lactam antibiotic unless erythromycin is unavailable, or the patient does not tolerate its administration
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