Morency Anne-Maude, Bujold Emmanuel
Department of Microbiology, Université de Montréal, Montréal, Québec, Canada.
J Obstet Gynaecol Can. 2007 Jan;29(1):35-44. doi: 10.1016/s1701-2163(16)32350-7.
As many as 50% of spontaneous preterm births are infection-related, with Mycoplasma species being the most common microbial isolates from the amniotic cavity. The goal of our study was to evaluate the effect of macrolides, a specific group of antibiotics known to be effective against Mycoplasma species, on the rate of preterm births.
We performed a systematic review of the literature and a meta-analysis. We searched PubMed, Medline (1965-March 2006), Embase, and the Cochrane Library, using the key words "pregnancy," "macrolides," "erythromycin," "azithromycin," and "clarithromycin." The research was limited to randomized controlled trials and to human females. Studies included for analysis were of women in the second trimester of pregnancy who received either macrolides or placebo (or no treatment) in order to prevent preterm delivery with at least 95% of patient follow-up. We excluded studies involving women with preterm premature rupture of membranes or regular uterine contractions. Meta-analysis of the retrieved data was performed using RevMan 4.2.8 (Cochrane Collaboration) with dichotomous analyses and delivery prior to 37 weeks' gestation as the primary outcome. The analysis was subsequently repeated using the same methodology for clindamycin and metronidazole administered during the second trimester.
Of the 61 articles yielded by our search, three original papers, investigating a total of 1807 women, examined macrolide utilization and met our criteria. Women included in our analysis were all considered to be at higher risk for preterm delivery (vaginal fetal fibronectin positivity, urogenital Mycoplasma infection, prior preterm delivery, and/or pregestational maternal weight < 50 kg). Compared with placebo, macrolides were associated with a lower rate of preterm births (odds ratio [OR] 0.72; 95% confidence intervals [CI] 0.56-0.93), as was clindamycin (OR 0.68; 95% CI 0.49-0.95). On the other hand, metronidazole (OR 1.10; 95% CI 0.95-1.29) was not linked with significant changes in the rate of preterm births. A higher rate of preterm delivery was found when mid-trimester metronidazole was the only antibiotic administered (OR 1.31; 95% CI 1.08-1.58).
Macrolides and clindamycin, given during the second trimester of pregnancy, are associated with a lower rate of preterm delivery, whereas second-trimester metronidazole used alone is linked with a greater risk of preterm delivery in a high-risk population. Use of metronidazole, a common treatment for bacterial vaginosis and Trichomonas vaginalis, should be avoided during the second trimester of pregnancy in this population.
多达50%的自然早产与感染相关，支原体是羊膜腔中最常见的微生物分离株。我们研究的目的是评估大环内酯类药物（一类已知对支原体有效的特定抗生素）对早产率的影响。
我们进行了文献系统综述和荟萃分析。我们检索了PubMed、Medline（1965年 - 2006年3月）、Embase和Cochrane图书馆，使用关键词“妊娠”“大环内酯类”“红霉素”“阿奇霉素”和“克拉霉素”。研究仅限于随机对照试验和人类女性。纳入分析的研究是妊娠中期接受大环内酯类药物或安慰剂（或未治疗）以预防早产且至少95%患者有随访的女性。我们排除了涉及胎膜早破早产或规律宫缩女性的研究。使用RevMan 4.2.8（Cochrane协作网）对检索到的数据进行荟萃分析，采用二分法分析，以妊娠37周前分娩作为主要结局。随后使用相同方法对妊娠中期使用克林霉素和甲硝唑的情况进行重复分析。
我们检索出的61篇文章中，3篇原创论文共研究了1807名女性，探讨了大环内酯类药物的使用情况并符合我们的标准。纳入我们分析的女性均被认为早产风险较高（阴道胎儿纤连蛋白阳性、泌尿生殖道支原体感染、既往早产和/或孕前体重<50 kg）。与安慰剂相比，大环内酯类药物与较低的早产率相关（比值比[OR] 0.72；95%置信区间[CI] 0.56 - 0.93），克林霉素也是如此（OR 0.68；95% CI 0.49 - 0.95）。另一方面，甲硝唑（OR 1.10；95% CI 0.95 - 1.29）与早产率的显著变化无关。当妊娠中期仅使用甲硝唑作为唯一抗生素时，发现早产率较高（OR 1.31；95% CI 1.08 - 1.58）。
妊娠中期使用大环内酯类药物和克林霉素与较低的早产率相关，而妊娠中期单独使用甲硝唑与高危人群中更高的早产风险相关。在该人群的妊娠中期应避免使用甲硝唑，甲硝唑是细菌性阴道病和滴虫性阴道炎的常用治疗药物。
