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Abstract
Background: Preterm pre-labor rupture of membranes (PPROM), defined as membrane rupture before 37 weeks of gestation, is a significant contributor to preterm births and associated fetomaternal morbidity. Infection is a major complication, with ascending infections leading to chorioamnionitis. While antibiotic prophylaxis is a standard management approach to prolong pregnancy latency and reduce neonatal infection rates, the optimal antibiotic regimen remains a subject of ongoing debate. Erythromycin-based regimens are widely used, but azithromycin has gained popularity due to its favorable side effect profile, convenience, and cost-effectiveness. This study was conducted to compare the efficacy of erythromycin and azithromycin regimens in managing PPROM in a local tertiary care setting.
Aim: To compare the outcomes of azithromycin and erythromycin for the management of preterm pre-labor rupture of membranes.
Methods: This was a randomized controlled trial conducted at the Gynaecology and Obstetric Department of Benazir Bhutto Hospital, Rawalpindi. A total of 380 pregnant females with PPROM between 24 and 36+6 weeks of gestation were enrolled and randomly assigned to two groups. Group A (n=190) received a regimen of intravenous ceftriaxone for 48 hours, followed by oral azithromycin and amoxicillin for 5 days. Group E (n=190) received intravenous ceftriaxone for 48 hours, followed by oral erythromycin and amoxicillin for 5 days. The primary outcome was the incidence of clinical chorioamnionitis, defined by a maternal temperature > 100.4°F with fetal tachycardia, along with other symptoms. Data were analyzed using SPSS v.26, with the chi-square test used for group comparisons.
Results: The incidence of clinical chorioamnionitis was significantly lower in the azithromycin group (Group A) compared to the erythromycin group (Group E). A total of 34 (17.9%) patients in Group A developed chorioamnionitis compared to 62 (32.6%) in Group E (p=0.001). The two groups were comparable in baseline characteristics, including age, gestational age, and parity. Subgroup analysis showed that the lower rate of chorioamnionitis in the azithromycin group was consistent across all age groups and parity statuses.
Conclusion: The findings of this study suggest that an antibiotic regimen containing azithromycin is more effective in reducing the incidence of clinical chorioamnionitis in patients with PPROM compared to a regimen containing erythromycin. This supports the use of azithromycin as a superior alternative for PPROM management in our local population to reduce associated morbidity.