Review Article

Antimicrobials for Preterm Birth Prevention: An Overview

Table 1

Summary of studies of empiric use of antibiotics for PTB prevention.

Study Antibiotic regimenGestational age at treatment(wks)Days treatmentPrimary outcomesBenefit

Beta lactams
Newton et al. (1991) [41]91IV ampicillin/sulbactam + PO indomethacinLess than 363(1) Gestational age at delivery
(2) Number of term deliveries
(3) Days gained
No
Cox et al. (1995) [42]78IV ampicillin/sulbactam + PO amoxicillin-clavulanate24–347Mean gestational age at deliveryNo
Gordon et al. (1995) [43]117IV ceftizoxime24–355Prolongation of gestationNo

Clindamycin
McGregor et al. (1991) [44]117IV and PO clindamycinLess than 347Interval to deliveryYes
(35 versus 25 days latency, )
Lamont et al. (2003) [45]4092% clindamycin cream(vaginal)13–203Incidence of preterm birthYes
(4% versus 10% rate of PTB )
Kekki et al. (2001) [46]54322% clindamycin cream (vaginal)10–177(1) Rates of preterm delivery
(2) Peripartum infection
No

Azithromycin
Van de Broek et al. (2009) [47]2297PO azithromycin16–24 and 28–322 dosesIncidence of preterm birthNo

Combination regimens
Norman et al. (1994) [48]81IV ampicillin/PO amoxicillin + PO metronidazole26–345(1) Days gained
(2) Perinatal mortality
(3) Perinatal morbidity
Yes
(15 versus 2.5 days latency, )
Svare et al. (1997) [49]112IV ampicillin/PO pivampicin + PO metronidazole26–347(1) Days to delivery
(2) Gestational age (GA) at delivery
(3) Rates of preterm delivery
(4) Low birth weight
(5) Maternal infection
(6) Neonatal infection
Yes
(1) (47.5 versus 27 days latency, )
(2) (37 versus 34 weeks GA at delivery, )
(3) (42% versus 65% preterm birth rate, )
Newton et al. (1989) [50]103IV Ampicillin/PO erythromycin24–357(1) Rate of preterm birth
(2) Time to delivery
(3) Birthweight
(4) Episodes of recurrent preterm Labor
No
Romero et al. (1993) [51]277IV Ampicillin/erythromycin + PO amoxicillin/erythromycin24–347(1) Time to delivery
(2) Frequency of preterm delivery
(3) Frequency of PROM
(4) Maternal outcomes
(5) Episodes of recurrent preterm labor
No
Oracle II (2001) [52]6295PO erythromycin or PO amoxicillin-clavulanate or bothLess than 3710Composite neonatal morbidity or mortalityNo