Azithromycin in the Treatment of Preterm Prelabor Rupture of Membranes Demonstrates a Lower Risk of Chorioamnionitis and Postpartum Endometritis with an Equivalent Latency Period Compared with Erythromycin Antibiotic Regimens

Daniel Martingano, Shailini Singh, Antonina Mitrofanova, Daniel Martingano, Shailini Singh, Antonina Mitrofanova

Abstract

Objective: To determine if antibiotic regimens including azithromycin versus erythromycin has an impact on pregnancy latency and development of clinical chorioamnionitis in the context of preterm prelabor rupture of membranes. Study Design. We conducted a prospective observational cohort study and followed all women receiving antibiotic regimens including either azithromycin or erythromycin in the context of preterm prelabor rupture of membranes. Primary outcomes were the duration of pregnancy latency period and development of chorioamnionitis. Secondary outcomes included neonatal sepsis with positive blood culture, cesarean delivery, postpartum endometritis, and meconium-stained amniotic fluid.

Results: This study included 310 patients, with 142 receiving the azithromycin regimen and 168 receiving the erythromycin regimen. Patients receiving the azithromycin regimen had a statistically significant advantage in overall rates of clinical chorioamnionitis (13.4% versus 25%, p = 0.010), neonatal sepsis (4.9% versus 14.9%, p = 0.004), and postpartum endometritis (14.8% versus 31%, p = 0.001). In crude and adjusted models, when comparing the azithromycin group with the erythromycin group, a decreased risk was noted for the development of clinical chorioamnionitis, neonatal sepsis, and postpartum endometritis. Pregnancy latency by regimen was not significantly different in crude and adjusted models.

Conclusion: Our study suggests that latency antibiotic regimens substituting azithromycin for erythromycin have lower rates and decreased risk of clinical chorioamnionitis, neonatal sepsis, and postpartum endometritis with no difference in pregnancy latency.

Conflict of interest statement

My coauthors and I have no potential conflicts of interest, real or perceived, and no honorarium, grant, or form of payment was given to anyone to produce the manuscript.

Copyright © 2020 Daniel Martingano et al.

Figures

Figure 1
Figure 1
Flow chart of patient selection. 379 patients were confirmed with PPROM. 69 patients were excluded: 23 for being less than 24 weeks of gestation, 21 for taking other antibiotics at time of presentation, 8 with cerclages in situ, 3 who received another antibiotic regimen for PPROM, and 14 with a congenital or lethal anomaly. Of the 310 patients who met the inclusion/exclusion criteria, 142 received azithromycin while 168 received erythromycin.
Figure 2
Figure 2
Mantel-Cox proportional hazard model with hazard ratios. This analysis demonstrated that all covariates in isolation did not effect pregnancy latency in the multivariable (adjusted) model.
Figure 3
Figure 3
Survival curve for pregnancy latency. This demonstrated no difference in pregnancy latency between treatment types (p = 0.64, log-rank test).
Figure 4
Figure 4
Adjusted survival curve for pregnancy latency. After controlling for covariates, the adjusted survival curves by treatment type were not noted to be significantly different (p = 0.90, log-rank test).

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