Azithromycin associated with lower rate of chorioamnionitis in preterm prelabor rupture of membranes

Reference

Seaman RD, Kopkin RH, Turrentine MA. Erythromycin vs azithromycin for treatment of preterm prelabor rupture of membranes: a systematic review and meta-analysis. Am J Obstet Gynecol 2022;226(6):794-801.

Synopsis

The American College of Obstetrics and Gynecology recommends expectant management and antibiotic treatment in the setting of preterm prelabor rupture of membranes (PPROM) before 34 weeks' gestation. The recommended regimen originally was intravenous erythromycin with ampicillin, followed by an oral regimen to complete 7 days. During a shortage of intravenous erythromycin in the United States, oral or intravenous azithromycin was commonly substituted and recognized as a suitable alternative. The authors of this meta-analysis of observational studies sought to compare outcomes of azithromycin regimens and erythromycin regimens. They included 5 cohort studies with 1289 women with PPROM before 34 weeks' gestation treated with erythromycin (n = 508) or azithromycin (n = 781 by either oral or intravenous route). All studies were rated as having low risk of bias, and a funnel plot did not suggest publication bias. Azithromycin regimens varied in duration from 1 day to 5 days. The most common azithromycin regimen was a single oral dose of 1 g. Mean gestational age and mode of delivery were similar among studies. Women who received erythromycin had a similar mean latency period between PPROM and delivery as women who received azithromycin (6.6 vs 6.7 days). Clinical chorioamnionitis was diagnosed in 25% (95% CI 12% - 32%) with erythromycin regimens and in 14% (9% - 24%) with azithromycin (odds ratio 0.53; 0.39 - 0.71). Rates of neonatal sepsis and neonatal respiratory distress syndrome were not significantly different between groups.