Is it mandatory to prescribe antibiotics to women who have a premature birth?

Women with premature births do not have to prescribe antibiotics, unless, of course, they have clinical signs of an infection process or a premature discharge of amniotic fluid. The March issue of The Lancet published the results of two studies by a research group on this issue.

The first study involved 6,295 women who gave birth prematurely. All of these women did not experience premature amniotic fluid rupture or clinical signs of infection. During the study, patients were randomized into 4 groups: 1 - 250 mg of erythromycin, 2 - 325 mg of co-amoxiclav, 3 - erythromycin + co-amoxiclav, 4 - placebo. All regimens and placebo were prescribed four times a day for 10 days.

None of the antibiotic regimens studied reduced the level of neonatal mortality, the incidence rate of chronic lung disease and the significant deviations of the central nervous system in newborns compared to placebo. However, in mothers receiving antibiotics, infections were less common.

In the second study, 4826 women with premature labor and a long anhydrous period were randomized into 4 groups: 1 - 250 mg of erythromycin, 2 - 325 mg of co-amoxiclav, 3 - erythromycin + co-amoxiclav, 4 - placebo. All regimens and placebo were also administered four times a day for 10 days.

Among 2,451 infants born to mothers who received only erythromycin, the level of neonatal mortality, the frequency of chronic lung disease and significant deviations from the central nervous system were lower than those of children whose mothers were taking placebo. However, in the groups where co-amoxiclav and co-amoxiclav + erythromycin were used, no positive results were obtained compared to placebo.

The use of co-amoxiclav and co-amoxiclav with erythromycin was significantly associated with a higher incidence of necrotizing enterocolitis in newborns, although these two regimens prolonged pregnancy.

According to the researchers, the results of the study showed that the use of a cheap and widespread antibiotic, such as erythromycin, in women with premature amniotic fluid flow, has a positive effect on many suffering children. respiratory and neurological disorders.

But some scientists do not share the researchers' point of view and believe that the arguments on the indications for the appointment of erythromycin in women with premature discharge of amniotic fluid are not convincing, and in many cases its use is inappropriate.