Among Women with prolonged rupture of membranes and fever which is better- dual antibiotic regimen or ampicillin alone?

For this purpose, the researchers performed a 10-year retrospective study of women with ROM >18h and intrapartum fever comprising 62 women who were treated with ampicillin and gentamicin for suspected intraamniotic infection and 79 in which these signs were absent, who were treated with ampicillin alone. The study's primary outcomes were neonatal early-onset sepsis (EOS) and endometritis rates. A comparison was drawn between the outcomes using multivariate and univariate analyses.

The authors reported the following findings:

• Among women who received ampicillin alone compared with dual therapy, rates were higher of endometritis (16.5% versus 3.2%), neonatal early onset sepsis (7.5% versus 0%), Enterobacteriaceae positive placental swab culture (67.9% versus 15.7%), and histopathological subchorionitis (25.3% versus 8.0%).
• Over 83% of Enterobacteriaceae isolates were ampicillin-resistant.
• Gestational age at delivery >41 weeks, meconium at delivery, ROM >24h and treatment with a single antibiotic agent were associated with the presence of a positive Enterobacteriaceae placental swab culture.

"We found that rates of neonatal EOS and postpartum endometritis were significantly higher among women with term prolonged ROM (>18h), who developed intrapartum fever (>38°) versus those with suspected IAI," the researchers wrote. They noted that the former group were treated alone with ampicillin, while the latter received dual therapy of gentamicin and ampicillin.

Reference:

Abu Shqara, R., Bang, S., Glikman, D., Lowenstein, L., & Frank Wolf, M. (2023). Single versus dual antibiotic regimen in women with term prolonged rupture of membranes and intrapartum fever: A retrospective study. Journal of Gynecology Obstetrics and Human Reproduction, 52(6), 102599. https://doi.org/10.1016/j.jogoh.2023.102599