Use of microbial cultures and antibiotics in the prevention of infection-associated preterm birth - 25/08/11

Doi : 10.1016/j.ajog.2004.03.014

Laura L Klein, MD, Ronald S Gibbs, MD
Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver, Colo USA

Abstract

Objective

The purpose of this study was to summarize recent evidence regarding infection-associated preterm birth and to make appropriate recommendations. Antepartum treatment of lower genital tract infection or bacterial colonization has been found to reduce the incidence of preterm birth in the case of asymptomatic bacteriuria and bacterial vaginosis in selected patients but has been proved to be ineffective for vaginal colonization with organisms such as Ureaplasma urealyticum and group B streptococcus

Study design

This is a clinical opinion based on a review of recent data related to 1) the association between lower genital tract infection and preterm birth and 2) antibiotic trials to prevent preterm birth.

Results

Antepartum treatment of lower genital tract infection or bacterial colonization has been found to reduce the incidence of preterm birth in the case of asymptomatic bacteriuria and bacterial vaginosis in selected patients, but has been proven to be ineffective for vaginal colonization with organisms such as Ureaplasma urealyticum and group B streptococcus. Large well-designed trials have shown that the routine administration of antibiotics to women with preterm labor and intact membranes is not beneficial; however, antibiotic regimens including macrolides are recommended for preterm premature rupture of the membranes.

Conclusion

Large well-designed trials have shown that the routine administration of antibiotics to women with preterm labor and intact membranes is not beneficial; however, antibiotic regimens that include macrolides are recommended for preterm premature rupture of the membranes.

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Keywords : Preterm birth, Infection, Antibiotic trial, Prematurity, Antibiotic

Plan

Infection-associated preterm birth

Antibiotic trials to prevent preterm birth

Antibiotic administration in antenatal treatment of infection or colonization

Antibiotic treatment in patients with premature labor

Antibiotic administration in PPROM

Why antibiotics have not decreased premature birth regularly

Concerns about antibiotic use in preterm labor or PPROM

Environment, host, and disease

Comment

Based on the March of Dimes Lecture presented at the 51st Annual Meeting of the American College of Obstetrics and Gynecology, New Orleans, La, April 26-30, 2003.
Reprints not available from the authors.