Prophylactic antibiotics for inhibiting preterm labour with intact membranes
King, JF and Flenady, V and Murray, LJ, Prophylactic antibiotics for inhibiting preterm labour with intact membranes, The Cochrane Library, (2) Article CD000246. ISSN 1469-493X (2002) [Refereed Article]
The contribution of subclinical genital tract infection to the aetiology of preterm birth is gaining increasing recognition, but the role of
prophylactic antibiotic treatment in the management of preterm labour is uncertain. Since rupture of the membranes is an important
factor in the progression of preterm labour, it is important to see if the routine administration of antibiotics confers any benefit, prior
to membrane rupture.
To assess the effects of prophylactic antibiotics administered to women in preterm labour with intact membranes, on maternal and
We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (May 2002), the Cochrane Controlled Trials Register
(The Cochrane Library, Issue 1, 2002), MEDLINE (1965 to May 2002). Other sources included contacting recognised experts and
cross referencing relevant material.
We updated the search of the Cochrane Pregnancy and Childbirth Group’s Trials Register on 30 April 2010 and added the results to
the awaiting classification section of the review.
Randomised trials which compared antibiotic treatment with placebo or no treatment for women in preterm labour (between 20 and
36 weeks’ gestation) with intact membranes.
Data collection and analysis
Standard methods of the Cochrane Collaboration and the Cochrane Pregnancy and Childbirth Group were used. Evaluation of
methodological quality and trial data extraction were undertaken independently by the authors. Results are presented using relative
risk for categorical data and weighted mean difference for continuous data.
This review has been updated (2002) to include data from the ’ORACLE II 2001’ trial (six times larger than the previous 10 trials
combined), which now dominates the results of this review. Meta-analysis of the 11 included trials (7428 women enrolled) shows a
reduction in maternal infection with the use of prophylactic antibiotics (relative risk 0.74, 95% confidence interval 0.64 to 0.87) but
fails to demonstrate a benefit or harm for any of the prespecified neonatal outcomes.
This review fails to demonstrate a clear overall benefit from prophylactic antibiotic treatment for pretermlabour with intact membranes
on neonatal outcomes and raises concerns about increased neonatal mortality for those who received antibiotics. This treatment cannot
therefore be currently recommended for routine practice. Further research may be justified (when sensitive markers for subclinical
infection become available) in order to determine if there is a subgroup ofwomenwho could experience benefit fromantibiotic treatment
for preterm labour prior to membrane rupture, and to identify which antibiotic or combination of antibiotics is most effective.