Erythromycin Can Prolong Pregnancy, Improve Neonatal Outcomes in pPROM.

Erythromycin has beneficial effects on the neonate when administered to a woman with pDreterm, premature rupture of the membranes, according to findings from two large trials.

But antibiotics are unwarranted in patients in preterm labor with intact membranes and no evidence of clinical infection, the studies showed.

In the trials--Oracle I, which included 4,809 women with preterm, prelabor rupture of the membranes (pPROM), and Oracle II, which included 6,241 women with spontaneous preterm labor with intact membranes--patients were randomized to receive 250 mg of erythromycin, 325 mg of co-amoxiclav (a combination of 250 mg of amoxicillin and 125 mg of clavulanic acid), a combination of the two, or placebo four times daily for 10 days.

The primary outcome measure was a composite of neonatal death, chronic lung disease, or major cerebral abnormality on ultrasound, Dr. S.L. Kenyon of the Leicester (England) Royal Infirmary and her colleagues reported.

Of 2,415 infants born to the women with pPROM in Oracle I who received erythromycin only or placebo, the 1,190 whose mothers received erythromycin were less likely to have the composite primary outcome. The difference was not statistically significant; 12.7% of those in the erythromycin group were affected, compared with 15.2% in the placebo group (Lancet 357[9261]:979-88, 2001).

When singleton pregnancies were considered separately, the differences between the erythromycin and placebo groups were statistically significant; 11.2% in the erythromycin group had the composite primary outcome, compared with 14.4% in the placebo group.

Furthermore, the erythromycin-only group experienced prolongation of pregnancy, compared with those in the placebo group. In the co-amoxiclav and co-amoxiclav plus erythromycin groups no significant difference in ...