Maternal and neonatal outcomes associated with expanded antibiotic therapy in preterm prelabor rupture of membranes

Abstract

OBJECTIVE: To compare maternal and neonatal outcomes in women with preterm prelabor rupture of membranes (PPROM) managed expectantly with either ampicillin-erythromycin or an institutional alternative regimen combining ampicillin, ceftriaxone, and clarithromycin. METHODS: weeks (January 2019-December 2024). Ampicillin-erythromycin was used from 2019 to 2022, and ampicillin-ceftriaxone-clarithromycin from 2023 to 2024. Primary outcomes included maternal infectious morbidity and early-onset neonatal sepsis. Latency was assessed using the restricted mean time to delivery (RMTD) from Kaplan-Meier curves. RESULTS: A total of 136 women were included: 64 received ampicillin-erythromycin and 72 received ampicillin-ceftriaxone-clarithromycin. The alternative regimen was associated with lower rates of clinical chorioamnionitis (16.7% vs. 32.8%; P = 0.044), maternal sepsis (1.4% vs. 14.1%; P = 0.006), postpartum endometritis (1.4% vs. 12.5%; P = 0.013), and early-onset neonatal sepsis (46.5% vs. 66.1%; P = 0.039). Latency was numerically longer but did not reach statistical significance (RMTD difference 1.39 days; 95% confidence interval [CI]: -2.40-5.18; P = 0.471). CONCLUSION: In expectantly managed PPROM before 35 weeks, ampicillin-ceftriaxone-clarithromycin was independently associated with a reduction in clinical chorioamnionitis after multivariable adjustment. The association with early-onset neonatal sepsis was present in analysis but attenuated after adjustment, and should be interpreted as exploratory. Prospective studies are needed to confirm efficacy, safety, antimicrobial resistance implications, and long-term neonatal outcomes.