Advertisement

Erythromycin vs azithromycin for treatment of preterm prelabor rupture of membranes: a systematic review and meta-analysis

Published:December 29, 2021DOI:https://doi.org/10.1016/j.ajog.2021.12.262

      Objective

      This study aimed to estimate the effect of erythromycin vs azithromycin on the duration of latency and the rate of clinical chorioamnionitis in women with preterm prelabor rupture of membranes by performing a systematic review and meta-analysis of the existing literature.

      Data Sources

      From inception to October 2021, we explored MEDLINE, Scopus, Embase, CINAHL, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials.

      Study Eligibility Criteria

      Studies comparing the duration of latency and the rate of clinical chorioamnionitis between women with preterm prelabor rupture of membranes who were treated with erythromycin and those who were treated with azithromycin at the time of diagnosis were included.

      Methods

      Here, 2 reviewers separately ascertained studies, obtained data, and gauged study quality. The mean length of latency and the rate of clinical chorioamnionitis were compared and mean differences and odds ratios with 95% confidence intervals were estimated.

      Results

      A total of 5 studies with 1289 women were identified. The mean length of latency in women with preterm prelabor rupture of membranes was similar between individuals treated with erythromycin and those treated with azithromycin: 6.6 days vs 6.7 days (mean difference, 0.07 days; 95% confidence interval, −0.45 to 0.60; I2, 0%). The median point prevalence rates of clinical chorioamnionitis were 25% (95% confidence interval, 12–32) in women treated with erythromycin and 14% (95% confidence interval, 9–24) in women treated with azithromycin. The overall clinical chorioamnionitis rate in women treated with azithromycin was lower than women treated with erythromycin (pooled odds ratio, 0.53; 95% confidence interval, 0.39–0.71; I2, 0%).

      Conclusion

      The administration of azithromycin in women with preterm prelabor rupture of membranes was associated with a similar latency period but a lower rate of clinical chorioamnionitis than the administration of erythromycin.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Waters T.P.
        • Mercer B.
        Preterm PROM: prediction, prevention, principles.
        Clin Obstet Gynecol. 2011; 54: 307-312
        • Mercer B.M.
        • Goldenberg R.L.
        • Moawad A.H.
        • et al.
        The preterm prediction study: effect of gestational age and cause of preterm birth on subsequent obstetric outcome. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.
        Am J Obstet Gynecol. 1999; 181: 1216-1221
        • Romero R.
        • Quintero R.
        • Oyarzun E.
        • et al.
        Intraamniotic infection and the onset of labor in preterm premature rupture of the membranes.
        Am J Obstet Gynecol. 1988; 159: 661-666
        • Mercer B.M.
        • Miodovnik M.
        • Thurnau G.R.
        • et al.
        Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.
        JAMA. 1997; 278: 989-995
        • Mercer B.M.
        • Arheart K.L.
        Antimicrobial therapy in expectant management of preterm premature rupture of the membranes.
        Lancet. 1995; 346: 1271-1279
      1. Prelabor rupture of membranes: ACOG Practice Bulletin, Number 217.
        Obstet Gynecol. 2020; 135: e80-e97
        • American Society of Health System Pharmacists
        Erythromycin lactobionate injection.
        American Society of Health System Pharmacists, 2019 (Available at:)
        • Committee on Practice Bulletins-Obstetrics
        ACOG Practice Bulletin No. 199: use of prophylactic antibiotics in labor and delivery.
        Obstet Gynecol. 2018; 132: e103-e119
        • Fitzgibbon A.
        • Clooney L.
        • Broderick D.
        • Eogan M.
        • McCallion N.
        • Drew R.J.
        Erythromycin compared to amoxicillin and azithromycin for antimicrobial prophylaxis for preterm premature rupture of the membranes: a retrospective study.
        J Obstet Gynaecol. 2021; 41: 569-572
        • Martingano D.
        • Singh S.
        • Mitrofanova A.
        Azithromycin in the treatment of preterm prelabor rupture of membranes demonstrates a lower risk of chorioamnionitis and postpartum endometritis with an equivalent latency period compared with erythromycin antibiotic regimens.
        Infect Dis Obstet Gynecol. 2020; 2020: 2093530
        • Pierson R.C.
        • Gordon S.S.
        • Haas D.M.
        A retrospective comparison of antibiotic regimens for preterm premature rupture of membranes.
        Obstet Gynecol. 2014; 124: 515-519
        • Finneran M.M.
        • Appiagyei A.
        • Templin M.
        • Mertz H.
        Comparison of azithromycin versus erythromycin for prolongation of latency in pregnancies complicated by preterm premature rupture of membranes.
        Am J Perinatol. 2017; 34: 1102-1107
        • Navathe R.
        • Schoen C.N.
        • Heidari P.
        • et al.
        Azithromycin vs erythromycin for the management of preterm premature rupture of membranes.
        Am J Obstet Gynecol. 2019; 221: 144.e1-144.e8
        • Ali A.I.
        Preterm premature rupture of membranes management with erythromycin versus azithromycin.
        Int J Pharm Res. 2020; 12: 2117-2122
        • Stroup D.F.
        • Berlin J.A.
        • Morton S.C.
        • et al.
        Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.
        JAMA. 2000; 283: 2008-2012
        • Wells G.A.
        • Shea G.
        • O’Connell D.
        • et al.
        The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.
        Ottawa Hospital Research Institute, 2014 (Available at:)
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Lo C.K.
        • Mertz D.
        • Loeb M.
        Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments.
        BMC Med Res Methodol. 2014; 14: 45
        • Hozo S.P.
        • Djulbegovic B.
        • Hozo I.
        Estimating the mean and variance from the median, range, and the size of a sample.
        BMC Med Res Methodol. 2005; 5: 13
        • DerSimonian R.
        • Laird N.
        Meta-analysis in clinical trials.
        Control Clin Trials. 1986; 7: 177-188
        • Higgins J.P.
        • Thompson S.G.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558
        • Egger M.
        • Davey Smith G.
        • Schneider M.
        • Minder C.
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Peters J.L.
        • Sutton A.J.
        • Jones D.R.
        • Abrams K.R.
        • Rushton L.
        Comparison of two methods to detect publication bias in meta-analysis.
        JAMA. 2006; 295: 676-680
        • Martin J.A.
        • Hamilton B.E.
        • Osterman M.J.K.
        • Driscoll A.K.
        Births: final data for 2018.
        Natl Vital Stat Rep. 2019; 68: 1-47
        • Mercer B.M.
        • Moretti M.L.
        • Prevost R.R.
        • Sibai B.M.
        Erythromycin therapy in preterm premature rupture of the membranes: a prospective, randomized trial of 220 patients.
        Am J Obstet Gynecol. 1992; 166: 794-802
        • Lee J.
        • Romero R.
        • Kim S.M.
        • et al.
        A new anti-microbial combination prolongs the latency period, reduces acute histologic chorioamnionitis as well as funisitis, and improves neonatal outcomes in preterm PROM.
        J Matern Fetal Neonatal Med. 2016; 29: 707-720
        • Amsden G.W.
        Advanced-generation macrolides: tissue-directed antibiotics.
        Int J Antimicrob Agents. 2001; 18: S11-S15
        • Witt A.
        • Sommer E.M.
        • Cichna M.
        • et al.
        Placental passage of clarithromycin surpasses other macrolide antibiotics.
        Am J Obstet Gynecol. 2003; 188: 816-819
        • Boelig R.C.
        • Lam E.
        • Rochani A.
        • Kaushal G.
        • Roman A.
        • Kraft W.K.
        Longitudinal evaluation of azithromycin and cytokine concentrations in amniotic fluid following one-time oral dosing in pregnancy.
        Clin Transl Sci. 2021; 14: 2431-2439
        • Fan H.
        • Gilbert R.
        • O’Callaghan F.
        • Li L.
        Associations between macrolide antibiotics prescribing during pregnancy and adverse child outcomes in the UK: population based cohort study.
        BMJ. 2020; 368: m331
        • Finneran M.M.
        • Smith D.D.
        • Buhimschi C.S.
        Cost analysis of azithromycin versus erythromycin in pregnancies complicated by preterm premature rupture of membranes.
        Am J Perinatol. 2019; 36: 105-110
        • Zuckerman J.M.
        • Qamar F.
        • Bono B.R.
        Review of macrolides (azithromycin, clarithromycin), ketolids (telithromycin) and glycylcyclines (tigecycline).
        Med Clin North Am. 2011; 95: 761-791
        • Sharp G.C.
        • Stock S.J.
        • Norman J.E.
        Fetal assessment methods for improving neonatal and maternal outcomes in preterm prelabour rupture of membranes.
        Cochrane Database Syst Rev. 2014; : CD010209