Prophylactic antibiotic administration in pregnancy

Routine antibiotic prophylaxis during the second or third trimester of pregnancy reduces the risk of prelabour rupture of the membranes. Beneficial effects in terms of birth weight and the risk of postpartum endometritis were seen for high-risk women. The data supporting the use of prophylactic antibiotics in women with specific risk factors are more compelling as there was a reduction in more substantive outcomes.

RHL Commentary by Anthony Akinloye Bamigboye

EVIDENCE SUMMARY

This review includes six well-conducted randomized double-blind trials. It shows that in unselected women who received systemic prophylactic antibiotics in the second and third trimesters of pregnancy there was a reduction in the risk of prelabour rupture of membranes (Peto odds ratio 0.32, 95% confidence interval 0.14–0.73). Prophylactic antibiotics also reduced the risk of low birth weight (Peto odds ratio 0.48, 95% confidence interval 0.27–0.84) and postpartum infectious morbidity in selected high-risk mothers. High-risk was defined in three of the six studies as women with a history of preterm deliveries, women with pre-pregnancy weight of less than 50 kg or women with a history of low birth weight babies of less than 2500 grams.

Vaginal administration of clindamycin in high-risk women who had a history of preterm birth did not offer any benefit; rather, it increased the risk of neonatal sepsis.

The search strategy was rigorous and all reports of studies that were identified as potentially eligible were assessed. Data extraction, analysis and presentation were clear and concise.

The full RHL commentary also includes sections on:

Relevance
- Magnitude of the problem
- Applicability of the results
- Implementation of the intervention
Research
References

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This document should be cited as: Anthony Akinloye Bamigboye. Prophylactic antibiotic administration in pregnancy to prevent infectious morbidity and mortality: RHL commentary (last revised: 3 August 2004). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com