COMPARISON OF AZITHROMYCIN VERSUS ERYTHROMYCIN IN PPROM FOR PREVENTION OF CHORIOAMNIONITIS AND NEONATAL SEPSIS

Abstract

Objective: To compare the maternal and neonatal outcomes of azithromycin and erythromycin regimens for antibiotic prophylaxis in women with preterm premature rupture of membranes (PPROM) at 32-36+6 weeks of gestation. Methods: At Lahore General Hospital, 210 women with PPROM took part in a randomized controlled trial. Participants were randomly assigned to two groups: Group A (Erythromycin): Oral erythromycin 250 mg QID for 10 days, with standard ampicillin/amoxicillin prophylaxis. Group B (Azithromycin): One gram of azithromycin on day one, plus standard ampicillin/amoxicillin prophylaxis. The primary outcomes were the rates of clinical chorioamnionitis and neonatal sepsis, as determined by standard clinical and laboratory criteria. Secondary outcomes included the latency period (the time between membrane rupture and delivery) and the mode of delivery. A sample size of 210 had 80% power to detect a ≥15% difference in chorioamnionitis rates (α = 0.05). The data was analyzed using the Student's t-test for continuous variables and the χ² test for categorical variables. Results: Baseline characteristics were similar across groups (mean maternal age 29 ± 4 years, mean gestational age 34 ± 1 weeks, spontaneous vaginal delivery ~52%, and cesarean section ~48%). Clinical chorioamnionitis was significantly lower in Group B (azithromycin) compared to Group A (erythromycin) (14.3% vs. 28.6%; χ²=5.54, p=0.019). Neonatal sepsis: Group B had a lower incidence compared to Group A (9.5% vs. 21.0%; χ²=4.46, p=0.035). There was no significant difference in latency period between Groups A and B (4.7 ± 1.2 days vs. 4.8 ± 1.1 days; p=0.62). The mode of delivery is comparable across groups (p>0.05). Conclusion: Azithromycin-based antibiotic prophylaxis in PPROM is associated with significantly lower rates of clinical chorioamnionitis and neonatal sepsis compared to erythromycin, regardless of latency or mode of administration. These findings indicate that azithromycin is a viable alternative to erythromycin for latency antibiotic therapy in PPROM.