No difference in outcomes with early vs late antibiotic prophylaxis for term premature rupture of membranes: a multicenter analysis

Background

Although guidelines suggest administering antibiotics 12 to 18 hours after the rupture of membranes in women with term premature rupture of membranes, in practice, clinicians tend to initiate prophylactic antibiotics as soon as possible to avoid risk of infection.

Objective

This study aimed to assess whether early administration of prophylactic antibiotics for term premature rupture of membranes reduces the incidence of maternal and neonatal infections.

Study Design

This multicenter prospective cohort study included women with term premature rupture of membranes. The participants were divided into early and late administration groups according to the duration between rupture of membranes and antibiotic use. The effectiveness outcomes included the incidence of puerperal infection, the incidence of total maternal infection, and the rate of neonatal sepsis, whereas the safety outcomes included the incidence of adverse reactions. Antibiotic use density was used to assess antibiotic consumption. The propensity score matching method was used to control for confounding factors.

Results

A total of 1099 women with term premature rupture of membranes were enrolled: 459 in the early 6-hour group (antibiotic administration within 6 hours) and 640 in the late 6-hour group (antibiotic administration after 6 hours) and 707 in the early 12-hour group (antibiotic administration within 12 hours) and 392 in the late 12-hour group (antibiotics administration after 12 hours). After propensity score matching, there were 300 women in each 6-hour group and 230 women in each 12-hour group. The baseline characteristics showed no significant difference between the matched groups (P>.05). The early 6-hour and 12-hour groups had lower maternal C-reactive protein levels than the late 6-hour and 12-hour groups (P<.05). However, no significant difference was observed in other maternal and neonatal outcomes (P<.05). Adverse reactions showed no statistically significant difference between the early and late treatment groups (P=1.000). Antibiotic use density was higher in the early treatment groups by 10.1 defined daily doses (6-hour groups) and 11.7 defined daily doses (12-hour groups).

Conclusion

There was no substantial difference in the efficacy and safety of antibiotics administered within 6 to 12 hours after rupture of membranes compared with that administered after 6 to 12 hours in women with term premature rupture of membranes. Delayed antibiotic use substantially reduced antibiotic consumption.