Archives of Gynecology and Obstetrics

, Volume 300, Issue 3, pp 569–573 | Cite as

Macrolide antibiotics roxithromycin vs. azithromycin for preterm premature rupture of membranes: a retrospective comparison

  • Hanoch SchreiberEmail author
  • Pnina Shitrit
  • Gili Man-El
  • Offra Engel
  • Arie Berkovitz
  • Tal Biron-Shental
Maternal-Fetal Medicine



Prophylactic antibiotics to prolong latency and reduce the risk of neonatal and maternal infections are used for preterm premature rupture of membranes. This study compared outcomes between two macrolides: roxithromycin given twice a day for a week and azithromycin, given as a single dose, which is more convenient.


Two local protocols were retrospectively compared: roxithromycin and ampicillin from July 2005 to May 2016, and azithromycin and ampicillin from May 2016 to May 2018. Inclusion criteria were singleton pregnancy, at 24–34 weeks of gestation upon admission with preterm premature rupture of membranes. Primary outcome was length of the latency period, defined as time from first antibiotic dose to 34 + 0 weeks, or spontaneous or indicated delivery prior to 34 + 0 weeks. Secondary outcomes were rates of chorioamnionitis, delivery mode, birth weight and Apgar scores.


A total of 207 women met inclusion criteria, of whom, 173 received penicillin and roxithromycin and 34 received penicillin and azithromycin. Baseline characteristics were similar between groups. The latent period was longer in the azithromycin group than in the roxithromycin group (14.09 ± 14.2 days and 7.87 ± 10.2 days, respectively, P = 0.003). Rates of chorioamnionitis, cesarean deliveries, Apgar scores and birth weights were similar between the groups.


Azithromycin compared to roxithromycin results in a longer latency period in the setting of preterm premature rupture of membranes at 24–34 weeks of gestation. Given its more convenient regimen and our results, it seems justified to use azithromycin as the first-line treatment for patients with preterm premature rupture of membranes.


Azithromycin Latency period Preterm premature rupture of membranes Prophylactic antibiotics Roxithromycin 



The authors thank Nava Jelin, MS for data analysis, and Faye Schreiber, MS for editing the manuscript. They are employees of Meir Medical Center.

Author contribution

HS: study conception and design, and manuscript revisions. PS: data collection, data analysis and interpretation, and manuscript writing. GM-E: data collection, data analysis and interpretation, and manuscript writing. OE: data collection, data analysis and interpretation, and manuscript writing. AB: data analysis and interpretation, and manuscript writing. TB-S: study conception and design, and data interpretation.


This study was not funded.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Meir Medical Center Ethics Committee in March 2018, approval number 0075-18-MMC. All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyMeir Medical CenterKfar SabaIsrael
  2. 2.Infectious Disease UnitMeir Medical CenterKfar SabaIsrael
  3. 3.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael

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