Antibiotic therapy in time of labour – the Slovenian recomendations
Abstract
Antibiotic agents are administered during the intrapartum period to prevent and treat maternal infection and to prevent neonatal disease. Short courses of antibiotics are used during the labour to prevent such infections as group B streptococci (GBS) in newborns, postpartum endometritis and to treat chorioamnionitis. Many trials have evaluated the use of prophylactic antibiotics to prolong the pregnancy (and subsequently improve neonatal outcomes) after premature rupture of membranes (PROM). Intravenous antibiotics recommended for women in active preterm labour are: Penicillin G: given as 3g (or 5MU) intravenously at first and then 1.5g (or 2.5MU) at 4-hourly intervals until delivery. For women allergic to penicillin: provided a woman has not had severe allergy to penicillin, a cephalosporin should be used. If there is any evidence of severe allergy to penicillin, vancomycin should be used. For women allergic to penicillin, Clindamycin is no longer recommended as the current resistance rate is high. Where infection of the membranes is diagnosed or suspected or where there is preterm prolonged rupture of membranes, broad spectrum intravenous antibiotics should be given which include adequate GBS cover (we recomend Cefazolin 2g i.v and then 1g at 8-hourly intervals until delivery). In PPROM we recomend as soon as possible after PPROM: ampicillin (2 g i.v. every 6 hours) for 48 hours plus azithromycin (1g p.o in onetime administration), followed by amoxicillin (500 mg p.o. every 8 hours) for 5 days unless delivery occurs.
Downloads
References
Royal College of Obstetricians and Gynecologists. The Prevention of Early-onset neonatal Group B Streptococcal Disease. Green-top guideline No. 36 July 2012. London: Royal College of Obstetricians and Gynecologist; 2012.
Society of Obstetricians and Gynaecologists of Canada. The Prevention of Early-Onset Neonatal Group B Streptococcal Disease. October 2013. Ottawa: Society of Obstetricians and Gynaecologists of Canada; 2013.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Screening and Treatment for Group B Streptococcus in Pregnancy. November 2012. Melbourne: Royal Australian and New Zealand College of Obstetricians and Gynaecologists; 2012.
Regan JA, Klebanoff MA, Nugent RP; Vaginal Infections and Prematurity Study Group. The epidemiology of group B streptococcal colonization in pregnancy. Obstet Gynecol. 1991 Apr;77(4):604–10. PMID:2002986
Baker CJ, Barrett FF. Transmission of group B streptococci among parturient women and their neonates. J Pediatr. 1973 Dec;83(6):919–25. https://doi.org/10.1016/S0022–3476(73)80524–4 PMID:4585831
Verani JR, McGee L, Schrag SJ; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease—revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010 Nov;59 RR-10:1–36. PMID:21088663
Baker CJ, Byington CL, Polin RA; Committee on Infectious Diseases; Committee on Fetus and Newborn. Policy statement—recommendations for the prevention of perinatal group B streptococcal (GBS) disease. Pediatrics. 2011 Sep;128(3):611–6. PMID:21807694
Regan JA, Klebanoff MA, Nugent RP, Eschenbach DA, Blackwelder WC, Lou Y, et al.; VIP Study Group. Colonization with group B streptococci in pregnancy and adverse outcome. Am J Obstet Gynecol. 1996 Apr;174(4):1354–60. https://doi.org/10.1016/S0002–9378(96)70684–1 PMID:8623869
Allen VM, Yudin MH, Bouchard C, et al.; INFECTIOUS DISEASES COMMITTEE. Management of group B streptococcal bacteriuria in pregnancy. J Obstet Gynaecol Can. 2012 May;34(5):482–6. https://doi.org/10.1016/S1701–2163(16)35246-X PMID:22555143
Schwope OI, Chen KT, Mehta I, Re M, Rand L. The effect of a chlorhexidine-based surgical lubricant during pelvic examination on the detection of group B Streptococcus. Am J Obstet Gynecol. 2010 Mar;202(3):276.e1–3. https://doi.org/10.1016/j.ajog.2009.10.860 PMID:20022579
Price D, Shaw E, Howard M, Zazulak J, Waters H, Kaczorowski J. Self-sampling for group B streptococcus in women 35 to 37 weeks pregnant is accurate and acceptable: a randomized cross-over trial. J Obstet Gynaecol Can. 2006 Dec;28(12):1083–8. https://doi.org/10.1016/S1701–2163(16)32337–4 PMID:17169231
Honest H, Sharma S, Khan KS. Rapid tests for group B Streptococcus colonization in laboring women: a systematic review. Pediatrics. 2006 Apr;117(4):1055–66. https://doi.org/10.1542/peds.2005–1114 PMID:16585299
Gardner SE, Yow MD, Leeds LJ, Thompson PK, Mason EO Jr, Clark DJ. Failure of penicillin to eradicate group B streptococcal colonization in the pregnant woman. A couple study. Am J Obstet Gynecol. 1979 Dec;135(8):1062–5. https://doi.org/10.1016/0002–9378(79)90737–3 PMID:391044
Ramus RM, McIntire DD, Wendel GD Jr. Antibiotic chemoprophylaxis for group B strep is not necessary with elective cesarean section at term [Abstract]. Am J Obstet Gynecol. 1999;180:S85.
Pearlman MD, Pierson CL, Faix RG. Frequent resistance of clinical group B streptococci isolates to clindamycin and erythromycin. Obstet Gynecol. 1998 Aug;92(2):258–61. PMID:9699763
Baecher L, Grobman W. Prenatal antibiotic treatment does not decrease group B streptococcus colonization at delivery. Int J Gynaecol Obstet. 2008 May;101(2):125–8. https://doi.org/10.1016/j.ijgo.2007.10.012 PMID:18082163
Fairlie T, Zell ER, Schrag S. Effectiveness of intrapartum antibiotic prophylaxis for prevention of early-onset group B streptococcal disease. Obstet Gynecol. 2013 Mar;121(3):570–7. https://doi.org/10.1097/AOG.0b013e318280d4f6 PMID:23635620
Ohlsson A, Shah VS. Intrapartum antibiotics for known maternal Group B streptococcal colonization. Cochrane Database Syst Rev. 2014 Jun;6(6):CD007467. https://doi.org/10.1002/14651858.CD007467.pub4 PMID:24915629
Sinha A, Yokoe D, Platt R. Intrapartum antibiotics and neonatal invasive infections caused by organisms other than group B streptococcus. J Pediatr. 2003 May;142(5):492–7. https://doi.org/10.1067/mpd.2003.154 PMID:12756379
Schrag SJ, Hadler JL, Arnold KE, Martell-Cleary P, Reingold A, Schuchat A. Risk factors for invasive, early-onset Escherichia coli infections in the era of widespread intrapartum antibiotic use. Pediatrics. 2006 Aug;118(2):570–6. https://doi.org/10.1542/peds.2005–3083 PMID:16882809
Mercer BM. Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am. 2005 Sep;32(3):411–28. https://doi.org/10.1016/j.ogc.2005.03.003 PMID:16125041
Melamed N, Hadar E, Ben-Haroush A, Kaplan B, Yogev Y. Factors affecting the duration of the latency period in preterm premature rupture of membranes. J Matern Fetal Neonatal Med. 2009 Nov;22(11):1051–6. https://doi.org/10.3109/14767050903019650 PMID:19900043
Practice bulletins No. 139: premature rupture of membranes. Obstet Gynecol. 2013 Oct;122(4):918–30. https://doi.org/10.1097/01.AOG.0000435415.21944.8f PMID:24084566
van der Ham DP, van der Heyden JL, Opmeer BC, Mulder AL, Moonen RM, van Beek JH, et al. Management of late-preterm premature rupture of membranes: the PPROMEXIL-2 trial. Am J Obstet Gynecol. 2012 Oct;207(4):276.e1–10. https://doi.org/10.1016/j.ajog.2012.07.024 PMID:22901981
Al-Mandeel H, Alhindi MY, Sauve R. Effects of intentional delivery on maternal and neonatal outcomes in pregnancies with preterm prelabour rupture of membranes between 28 and 34 weeks of gestation: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2013 Jan;26(1):83–9. https://doi.org/10.3109/14767058.2012.718388 PMID:22882130
Buchanan SL, Crowther CA, Levett KM, Middleton P, Morris J. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks’ gestation for improving pregnancy outcome. Cochrane Database Syst Rev. 2010 Mar;(3):CD004735. https://doi.org/10.1002/14651858.CD004735.pub3 PMID:20238332
van der Ham DP, Vijgen SM, Nijhuis JG, van Beek JJ, Opmeer BC, Mulder AL, et al.; PPROMEXIL trial group. Induction of labor versus expectant management in women with preterm prelabor rupture of membranes between 34 and 37 weeks: a randomized controlled trial. PLoS Med. 2012;9(4):e1001208. https://doi.org/10.1371/journal.pmed.1001208 PMID:22545024
Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006; CD004454.
Kenyon S, Boulvain M, Neilson JP. Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev. 2013;12:CD001058.
Workowski KA, Berman S; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010 Dec;59 RR-12:1–110. PMID:21160459
Pierson RC, Gordon SS, Haas DM. A retrospective comparison of antibiotic regimens for preterm premature rupture of membranes. Obstet Gynecol. 2014 Sep;124(3):515–9. https://doi.org/10.1097/AOG.0000000000000426 PMID:25162251
Mercer BM. PPROM: current approaches to evalutation and management. Obstet Gynecol Clin North Am. 2005;32:411. https://doi.org/10.1016/j.ogc.2005.03.003 PMID:16125041
Hutzal CE, Boyle EM, Kenyon SL, Nash JV, Winsor S, Taylor DJ, et al. Use of antibiotics for the treatment of preterm parturition and prevention of neonatal morbidity: a metaanalysis. Am J Obstet Gynecol. 2008 Dec;199(6):620.e1–8. https://doi.org/10.1016/j.ajog.2008.07.008 PMID:18973872
ACOG Committee Opinion No. ACOG Committee Opinion No. 445: antibiotics for preterm labor. Obstet Gynecol. 2009 Nov;114(5):1159–60. https://doi.org/10.1097/AOG.0b013e3181c33c86 PMID:20168128
Pierson RC, Gordon SS, Haas DM. A retrospective comparison of antibiotic regimens for preterm premature rupture of membranes. Obstet Gynecol. 2014 Sep;124(3):515–9. https://doi.org/10.1097/AOG.0000000000000426 PMID:25162251
Grigsby PL, Novy MJ, Sadowsky DW, Morgan TK, Long M, Acosta E, et al. Maternal azithromycin therapy for Ureaplasma intraamniotic infection delays preterm delivery and reduces fetal lung injury in a primate model. Am J Obstet Gynecol. 2012 Dec;207(6):475.e1–14. https://doi.org/10.1016/j.ajog.2012.10.871 PMID:23111115
Copyright (c) 2019 Slovenian Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
