Antibiotic choice for the management of preterm premature rupture of membranes in Taiwanese women

Background: Preterm premature rupture of membranes (PPROM) is one of the most common causes of preterm birth. Antibiotic treatment is recommended to prolong the pregnancy course and reduce fetal morbidity in women with PPROM. However, the guidelines for anti-biotic selection are based on studies done years ago, mostly in Western countries, which may not reflect the geographic, temporal, and ethnic variation in microbial colonization and infection in other parts of the world. We aimed to understand whether the antibiotics recom-mended by the current guidelines were sufficient to eradicate the majority of pathogens involved. Methods: This is a single-center retrospective study at a tertiary medical center in Taiwan with patients recruited from January 1, 2017, to December 31, 2019. All patient included had a confirmed diagnosis of PPROM. In this study, we aimed to investigate which broad-spectrum antibiotic was most suitable for PPROM cases in Taiwan. Results: 133 women were included, and 121 women had positive culture results. Most of the pregnant women had one positive result (35.5%). The most common pathogen was Lactoba-cillus species (27.8%), followed by Streptococcus species (12.9%) and Staphylococcus species (12.09%). Conclusion: The most appropriate antibiotic therapy for PPROM was a combination of 1 g azi-thromycin given orally on admission plus a third-generation cephalosporin administered intra-venously in the first 48 hours and followed by amoxicillin 500 mg per os for another five days.This recommended antibiotic regimen for women with PPROM needs further study under a ran-domized clinical trial with a larger study population to evaluate its efficacy. Copyright 2022, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Automated summary

This study aimed to investigate whether the antibiotics recommended by the current guidelines were sufficient to eradicate the majority of pathogens involved in PPROM. The results showed that the most suitable antibiotic therapy for PPROM in Taiwan was a combination of oral azithromycin 1g on admission, intravenous administration of a third-generation cephalosporin for 48 hours, followed by oral amoxicillin for five days. However, further randomized clinical trials with a larger study population are needed to evaluate the efficacy of this recommended antibiotic regimen.