Antibiotics for preterm, prelabour rupture of membranes

Evidence from a systematic review showing the effectiveness of use of antibiotics in the management of premature rupture of membranes (PROM) (1):

• administration of antibiotics after PROM is associated with a delay in delivery and a reduction in maternal and neonatal morbidity
• penicillins and erythromycin were associated with similar benefits, but erythromycin was used in larger trials and, thus, the results are more robust
• amoxicillin/clavulanate should be avoided in women at risk of preterm delivery because of the increased risk of neonatal necrotizing enterocolitis
• antibiotic administration after PROM is beneficial for both women and neonates

NICE note that (2):

• Antenatal prophylactic antibiotics for women with preterm premature rupture of membranes (P-PROM)
  • women with P-PROM should be offered oral erythromycin 250 mg 4 times a day for a maximum of 10 days or until the woman is in established labour (whichever is sooner)
    
    
  • if a women with P-PROM cannot tolerate erythromycin or in whom erythromycin is contraindicated, consider an oral penicillin for a maximum of 10 days or until the woman is in established labour (whichever is sooner)
    
    
  • do not offer women with P-PROM co-amoxiclav as prophylaxis for intrauterine infection
    
    
    

Reference:

1. Kenyon S et al. Antibiotics for preterm rupture of membranes: a systematic review. Obset Gynecol 2004;104:1051-7.
2. NICE (June 2022).Preterm labour and birth