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We appreciate the interest of Drs Nassar and Usta in our article.1
The short answer to their question, “Have the authors modified their policy regarding the choice of antimicrobials in PROM [preterm rupture of membranes],” is no. We have elected our approach based on the characteristics of our pregnant population and data accumulated over the years. Data reviews such as the Cochrane reviews and American College of Obstetrics and Gynecology practice bulletins may be used by a clinician in totality or modified based on the population of patients cared for.
The performance of daily genital tract culture for group B streptococcus (GBS) in patients with premature preterm rupture of membranes (PROM) was part of the study protocol. This was based on our experience with our patients who have a high carriage rate of GBS.
Leukocytosis was 1 of the parameters used in the clinical diagnosis of chorioamnionitis, but it was not the only one. Leukocytosis after administration of glucocorticoids usually occurs 24-48 hours after administration and then levels decline.2 White blood cell counts that continue to rise after this time period indicate subclinical chorioamnionitis.
Drs Nassar and Usta were very perceptive in reading our article concerning the latency period of patients with PPROM. There has been no randomized prospective study comparing aqueous penicillin prescribed alone with other antimicrobials and the duration of the latency period with PPROM. In our study, treating GBS carriage with aqueous penicillin, we noted that the duration of the latency period was similar to other published studies that used broad-spectrum antimicrobials.3 Perhaps broad-spectrum antimicrobials and/or combinations of such are not more efficacious than aqueous penicillin to prolong the latency period in patients with PPROM. However, broad-spectrum antimicrobials may encourage the emergence of resistant organisms for both the gravida and the newborn. We agree that further studies are necessary.
References
- . Duration of antimicrobial prophylaxis for group B streptococcus in patients with preterm premature rupture of membranes who are not in labor. Am J Obstet Gynecol. 2007;197:390–391
- . Dexamethasone induced leukocytosis in pregnancy. Brit J Obstet Gynecol. 1997;104:851–853
- . Duration of antibiotic therapy after preterm premature rupture of membranes. Am J Obstet Gynecol. 2003;189:799–802
PII: S0002-9378(08)00040-9
doi:10.1016/j.ajog.2008.01.025
© 2008 Mosby, Inc. All rights reserved.
Refers to article:
- Nonlaboring patients with preterm premature rupture of membranes: duration of antimicrobial prophylaxis , 25 March 2008
