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

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

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

Funding

This study was not funded.

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Author notes

  1. Hanoch Schreiber and Pnina Shitrit contributed equally.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St, 44281, Kfar Saba, Israel

    Hanoch Schreiber, Gili Man-El, Offra Engel, Arie Berkovitz & Tal Biron-Shental

  2. Infectious Disease Unit, Meir Medical Center, Kfar Saba, Israel

    Pnina Shitrit

  3. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Hanoch Schreiber, Pnina Shitrit, Gili Man-El, Offra Engel, Arie Berkovitz & Tal Biron-Shental

Authors
  1. Hanoch Schreiber
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  2. Pnina Shitrit
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  3. Gili Man-El
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  4. Offra Engel
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Contributions

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.

Corresponding author

Correspondence to Hanoch Schreiber.

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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.

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Schreiber, H., Shitrit, P., Man-El, G. et al. Macrolide antibiotics roxithromycin vs. azithromycin for preterm premature rupture of membranes: a retrospective comparison. Arch Gynecol Obstet 300, 569–573 (2019). https://doi.org/10.1007/s00404-019-05221-w

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  • DOI: https://doi.org/10.1007/s00404-019-05221-w

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