Day Kimberly N, Vircks Julie A, Henricks Christine E, Reaves Kaci M, Holmes Ashley K, Florio Karen L
Department of Pharmacy, Saint Luke's Hospital, Kansas City, MO, USA.
Division of Maternal-Fetal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
Ann Pharmacother. 2024 Mar;58(3):234-240. doi: 10.1177/10600280231181135. Epub 2023 Jun 26.
Treatment with antibiotics at the time of preterm prelabor rupture of membranes (PPROM) has been shown to prolong pregnancy. Due to the recurrent shortage of erythromycin, azithromycin has been substituted in the traditional regimen; however, there are little data on optimal dosing.
The objective of this study was to determine whether there is a difference in latency from onset of PPROM to delivery in patients who received a single dose of azithromycin compared with a 5-day course.
This was a single-center, multisite, retrospective, IRB approved analysis of patients admitted with a diagnosis of PPROM. Patients were included if rupture occurred between 22 0/7 and 33 6/7 weeks of gestation and received either a single dose or a 5-day course of azithromycin along with a beta lactam.
A total of 376 patients were reviewed with 296 patients included in the final analysis. There was no statistical difference in the primary outcome of latency days in patients who received the 5-day versus the single-dose course (4 vs 5 days, = 0.641). There was a significantly higher rate of histologic chorioamnionitis in the single-dose course of azithromycin (46.4% vs 62.6%, = 0.006).
There was no difference in latency for patients who received a 5-day course of azithromycin versus a single dose for the treatment of PPROM. A higher rate of histologic chorioamnionitis was observed in those who received the single-day course. Prospective follow-up studies are needed to confirm these findings.
胎膜早破（PPROM）时使用抗生素治疗已被证明可延长孕周。由于红霉素反复短缺，阿奇霉素已被用于替代传统治疗方案；然而，关于最佳剂量的数据很少。
本研究的目的是确定接受单剂量阿奇霉素治疗的患者与接受5天疗程阿奇霉素治疗的患者相比，从PPROM发作到分娩的潜伏期是否存在差异。
这是一项经机构审查委员会（IRB）批准的单中心、多中心回顾性分析，纳入诊断为PPROM的住院患者。纳入妊娠22⁰/₇至33⁶/₇周之间发生胎膜破裂且接受单剂量或5天疗程阿奇霉素加β-内酰胺类药物治疗的患者。
共审查了376例患者，最终分析纳入296例患者。接受5天疗程与单剂量疗程的患者，潜伏期天数这一主要结局无统计学差异（4天对5天，P = 0.641）。阿奇霉素单剂量疗程组的组织学绒毛膜羊膜炎发生率显著更高（46.4%对62.6%，P = 0.006）。
治疗PPROM时，接受5天疗程阿奇霉素治疗的患者与接受单剂量阿奇霉素治疗的患者在潜伏期方面无差异。接受单剂量疗程的患者组织学绒毛膜羊膜炎发生率更高。需要进行前瞻性随访研究以证实这些发现。
