cefoxitin and Fetal-Membranes--Premature-Rupture

Mixed results have been obtained in several studies using tocolysis or antibiotics individually in the treatment of premature rupture of membranes (PROM). We compared the outcomes of a management protocol consisting of tocolysis, prophylactic antibiotic administration, and documentation of pulmonary maturity with a control group treated with passive expectant management for premature rupture of membranes. There were 55 women in the treatment group and 57 women in the control group. The mean latent phase (+/- SEM) in the treatment group was 7.34 (+/- 1.25) days compared with 1.86 (+/- .431) days in the control group (P less than .001). Eighteen of 55 patients (33%) in the treatment group were electively delivered after documentation of lung maturity, contributing to a falsely lowered mean latent phase in the treatment group. Twenty-four patients in the treatment group and 6 in the control group had a latent phase of 5 days or greater (P = .00018). There were 9 postpartum infections in the control group and 10 infections in the treatment group (P = NS). There was no difference in the length of latent phase of patients treated with ceftizoxime compared with the other antibiotics used (cefoxitin, cefazolin, ampicillin), although postpartum ceftizoxime was more effective in preventing postpartum infections (1 of 28 vs 9 of 27) (P = .005). There were fewer infected neonates in the study group, but this was not significant. It appears that treatment with this protocol significantly prolongs the latent phase in patients with preterm PROM without increasing infectious morbidity.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Cefazolin; Cefoxitin; Ceftizoxime; Female; Fetal Membranes, Premature Rupture; Fetal Monitoring; Fetal Organ Maturity; Humans; Infant, Newborn; Lung; Obstetric Labor, Premature; Pregnancy; Puerperal Infection; Retrospective Studies; Tocolysis; Uterine Contraction

Despite recent enthusiasm for antibiotic prophylaxis by uterine irrigation at the time of cesarean section, no data exists comparing the efficacy of this technique with standard intravenous antibiotic administration. Therefore, 124 patients about to undergo cesarean section were entered into a prospective, randomized, double-blind evaluation of uterine irrigation versus intravenous administration of either normal saline or cefoxitin. All women were considered to be at increased risk for postoperative infection because of the presence of labor or ruptured membranes. The incidence of endometritis and the fever index in patients receiving intravenous cefoxitin (3.2%, 4.6 degree hours) was significantly less than in patients receiving intravenous normal saline (21.2%, 22.3 degree hours). There was no significant difference between the use of intravenous normal saline and uterine irrigation with either cefoxitin (18.9%, 16.6 degree hours) or normal saline (17.4%, 24.6 degree hours). These results suggest that intravenous infusion is the most effective means of administering cefoxitin as a prophylactic antibiotic.

Topics: Adult; Cefoxitin; Cesarean Section; Clinical Trials as Topic; Endometritis; Female; Fetal Membranes, Premature Rupture; Humans; Infusions, Parenteral; Pregnancy; Premedication; Prospective Studies; Random Allocation; Sodium Chloride; Therapeutic Irrigation

The authors present the results of the study of transplacental transfer of 3 recent beta lactam antibiotics: amoxicillin, cephradin and cefoxitin. The experiment was carried out in 37 pregnant women who had a premature rupture of membranes or who were undergoing a cesarean section. In these patients antibiotherapy was indicated in view of a possible superinfection. The results of the study show a worthwhile transplacental penetration of the 3 drugs tested. The concentrations achieved in umbilical cord blood and amniotic fluid increase with time and finally exceed the levels measured in maternal blood, after a period of time varying from 2 to 4 hours according to the drug and the route of administration.

Topics: Amniotic Fluid; Amoxicillin; Cefoxitin; Cephalosporins; Cephradine; Female; Fetal Blood; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Maternal-Fetal Exchange; Pregnancy; Pregnancy Complications, Infectious; Time Factors