Use of antibiotics for the treatment of preterm parturition and prevention of neonatal morbidity: a metaanalysis

OBJECTIVE: We conducted a metaanalysis to determine whether antibiotics prolong pregnancy and reduce neonatal morbidity in preterm premature rupture of membranes (PPROM) and preterm labor (PTL) at 34 weeks or less. STUDY DESIGN: Randomized trials comparing antibiotic therapy with placebo in PPROM or PTL at a gestation of 34 weeks or less were retrieved. The primary outcome was time to delivery (latency). Infant outcomes included mortality, infection, neurological abnormality, respiratory disease, and neonatal stay. RESULTS: Antibiotics were associated with prolongation of pregnancy in PPROM (P < .01) but not PTL. Clinically diagnosed neonatal infections were reduced in both groups; there was a trend toward reduced culture-positive sepsis in PPROM. Intraventricular hemorrhage (all grades) was reduced in PPROM. Other neonatal outcomes were unaffected by antenatal antibiotics. CONCLUSION: Antibiotics prolong pregnancy and reduce neonatal morbidity in women with PPROM at a gestation of 34 weeks or less. In PTL at a gestation of 34 weeks or less, there is little evidence of benefit from administration of antibiotics.